Colorectal endoscopic submucosal dissection (ESD) is a useful technique for resecting large colorectal tumors, but it is technically difficult. The difficulties include patients’ breathing, presence of severe fibrosis, and difficult locations.1-3 One difficult location is the dentate line area because of an abundance of hemorrhoidal vessels (Fig. 1). Clutch Cutter (Fujifilm Co, Tokyo, Japan) is a unique scissor-shaped serrated knife (Fig. 2A).4 This knife enables mucosal incision and submucosal dissection.