Endoscopic submucosal dissection (ESD) was initiated with an incision distal to the anal verge, involving 50% of its circumference, followed by the creation of a tunnel in an oral direction. A proximal mucosal incision was made to establish the tunnel ́s endpoint. Progressive widening of the tunnel was performed until complete en bloc resection. Rectal tumors extending to the dentate line are endoscopically demanding to remove. Reasons for that include reduced scope manoeuvrability in the narrow anal canal, increased risk of bleeding due to the rectal venous plexus and higher vascularity, as well as the need to perform mucosal incision distal to the dentate to assure free distal margin, inducing anal pain through sensory nerves in the anoderm. There is also the theoretical risk of systemic bacteraemia because of direct drainage to the systemic circulation. The combination of anoderm incision, tunnel creation and retroversion allows en bloc ESD in such challenging lesions.