Endoscopic submucosal dissection (ESD) shows promise for safely resecting rectal neoplasms near the dentate line, improving surgical options.

• En bloc resection rates reached 93.7% and R0 resection rates were at 85.4% in 255 patients.
• Overall adverse events occurred in just 8.7%, with manageable complications like bleeding (5.1%).

This technique could replace traditional transanal methods, but careful patient selection and planning are crucial for optimal outcomes.