Rectal neoplasm with submucosal fibrosis is an extremely challenging target for endoscopic submucosal dissection (ESD). It is the major causative factor for incomplete resection and adverse events (1,2), which is attributable to the impossible separation of the submucosa from muscularis and hence, inaccurate identification of the dissection line (3,4). A novel entire traction method was applied to deal with this subset of tumors.