Early rectal cancers that are difficult to resect with standard EMR/ESD, particularly those with fibrosis or MRS+, may require resection in deeper planes with methods such as endoscopic intermuscular dissection (EID) or exposed full-thickness resection (EFTR), which can leave deep bowel wall defects. We report a hybrid EID–EFTR approach combined with selective muscular-layer suturing. A 27-mm Isp JNET 2B lesion 4 cm from the anal verge, with prior biopsies suggesting at least intramucosal neoplasia and MRI cT1–2N0 staging, was removed en bloc, creating a varying thickness defect. Two sutures reapproximated the muscularis propria, leaving the mucosa open. Recovery was uneventful. Pathology showed a moderately differentiated pT1b adenocarcinoma (2083 μm invasion, no LVI, Bd1). This hybrid technique may enhance organ-sparing management of selected early rectal cancers.