We present a traction-assisted endoscopic submucosal dissection (ESD) of a 35-mm granular heterogeneous LST involving the ileocecal valve and extending into the terminal ileum. The procedure was initiated from the ileal side using a transparent cap to separate the villi and obtain a stable view for the first mucosal incision and submucosal entry. Dissection then progressed toward the colonic portion of the lesion. Clip-band traction provided optimal exposure across the valve, enabling a safe and controlled resection. The lesion was removed en bloc without complications. Histology confirmed a tubulovillous adenoma with low-grade dysplasia and R0 margins.