Endoscopic submucosal dissection of challenging rectosigmoid anastomotic lesion made feasible by a multipolar adaptive traction device combined with a line

Endoscopic submucosal dissection (ESD) is widely accepted as a minimally invasive treatment for most superficial colorectal neoplasms, enabling a high rate of en bloc R0 resection [1]. However, ESD is difficult to perform in selected cases, such as in anastomotic lesions following colorectal surgery. In such instances, ESD presents technical challenges due to severe fibrosis, limited space, the presence of staples, deformities, and suture lines from previous surgeries, which increase the risk of complications and unsuccessful outcomes [2] [3].