Patients with inflammatory bowel disease (IBD) carries an increased risk of colorectal cancer. High-risk colitis-associated neoplasia (HR-CAN) is a recently validated definition, which encompasses all non polipoid lesion > 20 mm or polipoid lesion with submucosal invasion stigmata independently from diameter, arising in an inflammed or mucosal healing segment.

These lesions are thought to carry higher neoplastic risk, so that they should be resected en bloc, preferably with endoscopic submucosal dissection (ESD), even though this approach is often markedly challenging, as a consequence of severe fibrosis.

We present a case where undersaline pocket method strategy allowed safe, quick and efficient en bloc resection of a descendent colon HR-CAN.