A 80-year-old man was referred for a Paris 0-IIa lesion of 15 mm, occurring on a colorectal anastomosis. Multiple removal and avulsion attempts were made without success. We initially started with circumferential incision, then we dissect the residual submucosa, deepening into the scarring fibrosis, achieving en-bloc full-thickness resection. The wall defect was completely sealed with an Endoscopic Suturing System (ESS). No adverse events occurred. The patient was dismissed two days after the procedure. Histological analysis revealed tubular-villous adenoma with low grade dysplasia, free horizontal and vertical margins. E-EFTR seems to be a technically demanding but safe and effective treatment for recurrent and fibrotic lesion, even on a surgical anastomosis.