Post-resection stenosis significantly impacts surgical outcomes for colorectal lesions treated with endoscopic submucosal dissection when over 90% of the circumference is involved.

• Stenosis rates reached 34.2%, higher for rectal lesions (38.2%) compared to colonic (11.6%).
• Complete resection was achieved in 85.1% of cases, with oncological resection rates of 80.3%.

Effective endoscopic treatments resolved all stenosis cases, eliminating the need for further surgery.

• Key predictors for stenosis included rectal location and larger lesion size, guiding patient selection and management strategies.