The efficacy of endoscopic submucosal dissection (ESD) has been well documented, however Western data on colorectal ESD is limited and its role for colorectal lesions is, at present, not well defined. Nevertheless, the rectum is recognized as a particular segment and ESD may play an important role in avoiding a major surgery. This study aims to report the feasibility, safety and effectiveness of ESD for treating premalignant and early malignant rectal lesions in a Western center. Methods: Prospective data analysis of all consecutive rectal lesions treated by ESD between 2013 and 2019. En bloc, pathological complete resection (R0) and curative rates, procedure time, complications and local recurrence were evaluated.