Colonoscopic picture of patient 1 at first presentation showing stenosis of the sigmoid which could not be passed by the colonoscope (A). Endoscopic snare debulking of the distal part of the tumor allowed to push the wire beyond the stenosis (B). After passing the tumor APC ablation of the proximal part of the tumor could be performed opening a channel (C). View of the stenosis after complete debulking. Note the channel with stool covering the luminal surface (D).