We performed a case-control study of DBA-ESD vs C-ESD for colon lesions using propensity score matching of cases and controls from a large prospective US single center cohort with a high volume of challenging lesions including 50% with prior manipulation and difficult locations. The DB platform, by offering endoscope stabilization and easy insertion of the endoscopic suturing device for secure ESD defect closure, increased colon ESD speed, reduced overall ESD time, decreased LOS and increased the same-day discharge rate.