The patient was found to have mid-esophageal erosion on gastroscopy and biopsy pathology suggested severe atypical hyperplasia (precancerous lesion), while ultrasound endoscopy showed that the lesion was confined to the mucosal layer and no surrounding lymph node metastasis was seen. Pathology after minimally invasive endoscopic surgery suggested complete resection of the lesion (negative margins), and no recurrence was observed on review. Previously, if severe atypical hyperplasia or carcinoma in situ of the esophagus was detected, open surgery was usually chosen, which was prone to postoperative complications such as fistula and infection. Endoscopic surgical treatment provides patients with a minimally invasive treatment method with definite efficacy.