Successful balloon overtube-guided colorectal endoscopic submucosal dissection by a gastroscope.

Colorectal ESD can achieve en-bloc resection. However, cecum, hepatic and splenic flexures are difficult locations because of unstable scope maneuvers and narrow working space. In these cases, balloon overtube-guided ESD may confer a better approach, improving the access to the lesion and scope manoeuvres. This overtube has a large outer diameter and enables the use of a therapeutic gastroscope. The procedure can also facilitate traction-assisted techniques allowing a high-rate of en-bloc resections. In addition, large specimens can be easily retrieved through.