Among the greatest difficulties in learning ESD in our environment, at least for me, is the approach to lesions in the right colon or those locations distal to the sigmoid colon when one or more loops are formed (generally in sigmoid and / or or transverse colon). Faced with this situation we can find ourselves with several problems. One of them may be that the lesion cannot be accessed with a short colonoscope or even though it is reached with a long colonoscope, the maneuverability and stability can make the technique very difficult. In fact, in my experience, this is the main reason for conversion to mucosectomy. Among the different options that exist to treat these lesions using ESD is the use of double balloon colonoscopes (Fujifilm model EI-580 BT). This endoscope, based on the double balloon enteroscopy technique, has a 3.2 mm channel and the working length of a standard long colonoscope (1550 mm). It allows the reduction of loops and to be able to maneuver properly in the ESD. The only drawback that I see is that it does not have a waterjet channel. This can be stressful if significant bleeding occurs. As seen in the video, Professor Yamamoto uses a valve for the US-Endoscopy working channel that has a luer-lock connecting cable to the wash source cable. This can be a substitute for the water jet although it does not have the pressure of the jet like this one. In any case, it can be an alternative to ERM and ESD in difficult locations of colorectal ESD.