Indication of ESD for colorectal tumor has been clearly described in (JGES) colorectal ESD/EMR guidelines (Table 7.1). Completely same contents have been described in the guidelines for management of colorectal polyp management from JSGE. According to these guidelines, indication for ESD is the large-sized (larger than 20 mm in diameter) tumors in which en bloc resection is difficult using conventional snare EMR, although it is indicative for endoscopic treatment. Concretely, lesions as follows are indicative for ESD: LST of the non-granular type (LST-NG), particularly those of the pseudo-depressed type, tumors showing Vi-type pit pattern, carcinoma with submucosal infiltration, large depressed-type tumors, and large elevated lesion suspected to be carcinoma (including LST-G, nodular mixed type). Further, mucosal tumors with fibrosis caused by prolapse due to biopsy or peristalsis of the lesions are also indicative for ESD, because lesion with fibrosis shows non-lifting sign and en bloc EMR is difficult. Sporadic localized tumors in chronic inflammation such as ulcerative colitis are indicative for ESD as well. As for ulcerative colitis-related carcinoma, the indication of endoscopic treatment has been under discussion because of the difficulty in the diagnosis of demarcation line and complete en bloc endoscopic resection. Local residual early carcinoma after endoscopic resection is also indicative for ESD. If local residual lesion is adenoma, additional EMR or ablation is enough for cure.