AbstractBackground and AimsColorectal endoscopic vacuum therapy (CR EVT) is usually performed using sponges passed through the anus. It may be associated with patient discomfort and displacement of the aspiration tube.MethodsWith the tube‐in‐tube endoscopic vacuum therapy modification (CR TT‐EVT), it is possible to position the aspiration tube in the pelvic cavity through the abdominal wall. In addition, it allows frequent cleaning of the fistula, eliminates the need for programmed device changes, and enables a standardized approach to such a wide variety of fistulas, leaks, and perforations.ResultsHere is a technical note on how to perform CR TT‐EVT, while we are at the early phase of our case series we have reached 100% of technical success.