Background　and　Aims:　Deep　endotracheal　intubation　(DET)　has　been　proposed　to　improve　cervical　esophageal　endoscopic　submucosal　dissection　(ESD)　because　of　the　limited　space　and　visibility.　We　aimed　to　evaluate　the　efficacy　and　safety　of　DET.　Methods:　In　the　current　dual-center　trial,　patients　were　randomized　into　DET　or　conventional　endotracheal　intubation　(CET)　groups.　Complete　resection　rate,　operation　time,　and　adverse　events　were　measured　and　compared.　Results:　Fifty-nine　patients　(60　lesions)　were　assigned　to　the　groups,　showing　comparable　baseline　characteristics.　The　complete　resection　rates　were　similarly　high　in　both　groups.　However,　DET　significantly　reduced　ESD　operation　time　(52.2　minutes　vs　71.1　minutes,　P　＜　.001)　and　postoperative　pain　scores　(3.1　vs　4.7,　P　＜　.01).　Severe　stenosis　occurred　more　frequently　in　the　CET　patients　(20%　vs　0%,　P　=　.035).　No　significant　differences　were　observed　in　other　adverse　events.　Conclusions:　DET　can　overcome　technical　challenges　to　improve　therapeutic　efficiency　and　safety.　(Clinical　trial　registration　number:　NCT06420258.)　©　2024　American　Society　for　Gastrointestinal　Endoscopy