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Background and Aims: We aimed to evaluate the feasibility, safety and efficacy of endoscopic submucosal dissection for recurrent rectal neoplastic lesions after transanal microsurgery of superficial rectal neoplasms., Methods: Multicenter retrospective study., Main Outcomes: recurrence at first endoscopic follow-up, En bloc, R0 and curative resections., Results: 39 patients were included. 71 % percent of lesions were located in the lower rectum, 57 % reached the pectineal line. 67 % were laterally spreading tumor granular type, 33 % were protruding lesions. Median size was 41 mm (IQR 30 - 60). Median operation time was 70 min (IQR 35 - 97). 92 % were successfully resected en bloc. R0 and curative resection rates were 77 % and 71 %, respectively. Perirectal fat was visualized in 10 patients, none of them required surgery. One significant hematochezia (3 %), two stenosis (6 %) and one untreatable anal incontinence (3 %) occurred. Median hospital stay after endoscopic submucosal dissection was 2 days (IQR 1-2). Median period for the first endoscopy follow-up was 6 months (IQR 4-8). A single post endoscopic submucosal dissection recurrence adenoma was found during follow-up (3 %), occurring after a non-en bloc resection., Conclusion: Endoscopic submucosal dissection is a good option for safely achieving high rates of complete en bloc resection in cases of recurrent superficial rectal tumor after transanal microsurgery., Competing Interests: Conflict of interest - Ali Jaafar has no conflict of interest. - Xavier Dray is co-founder and shareholder of Augmented Endoscopy. He has received consultant fees from Norgine and Provepharm. He has received lecture fees from Fujifilm, Medtronic, MSD, Norgine, Pfizer and Sandoz. - Jeremie Jacques has received workshop fees from Olympus, Fujifilm, Erbe, Pentax and Boston. He has received hospitality from Janssen and Abbvie. - Romain Legros has received workshop fees from Olympus, Fujifilm, Erbe, Pentax and Boston. - Sarah Leblanc has received workshop fees from Olympus and Boston. She has received congresses fees from Fujifilm. She is laboratory board for Alfasigma. - Vincent Lepilliez has received workshops fees from Olympus. He has refunded fees from Medtronic on JFHOD 2023. - Arthur Berger has received fees from Fujifilm, Norgine, Creo medical and Janssen. - Edouard Chabrun has received workshops fees from Norgine. - Yann Le Baleur is expert training consultant for Ovesco Endoscopy and Duomed. - Mathieu Pioche is co-founder of A-TRACT. He has received ESD formation fees from Olympus, Pentax and Erbe. He has received formation fees from Norgine and Provepharm. - Maximilien Barret is consulting for Medtronic, Sanofi and Fujifilm. He has participated in boards for Norgine and Ambu. He has received interventions fees from Dr. Falk Pharma. He organized training sessions for Olympus. He participated in research funding for Pentax - Timothee Wallenhorst, Thibault Degand and Felix Corre had no conflict of interest. - Marion Schaefer has received lecture and workshops fees from Boston scientific, workshop fees from Duomed Endoscopy and Erbe, lecture fees from Norgine, Alfasigma and Ferring. She is consulting for Abbvie. She has received hospitality from Cook, Olympus, Janssen, MSD, Pfizer, Cousin, Ipsen and Takeda., (Copyright © 2024 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)