Endoscopic submucosal dissection (ESD) for en bloc resection of colorectal lesion is a safe and effective method that has became the standard of practise in the Eastern World. Experience with ESD in the Western World is extremely limited because training opportunities with gastric cancer ESD, which is easier and safer, are rare. The aim of the study is to evaluate the feasibility, safety and the learning curve of the procedure in the italian setting. A total of 86 consecutive patients with 91 colorectal lesions were enrolled . All procedures were performed by a single operator. 77 ESD were completed (81,82%) and 14 (18,18%) were coverted to endoscopic piece meal mucosal resection (EPMR). Lesions, with a size range from 15 to 100mm (mean 35 +-14) were located in cecum 6 (7,8%), ileocecali-valve 1 (1,3%), right sided colon 24 (31,2%), left sided colon 16 (20,8%) and rectum 30 (39%). The data were recorded prospectively. En bloc resection was feasible in 67 lesions (87%), and R0 resection rate was 85,1% (57 Patients) in the en bloc resections group. Mean procedure time was 171+-83 min. No significative differences were found among the different periods of the learning curve (Table 2). Major complications rate was 9,1% (post operative perforation 5,2%, delayed bleeding 3,9%). Two perforated patients underwent surgical procedure, one patient (1,3%) needed endoscopic positioning of transrectal drenage, and one patient required conservative treatment with antibiotics. Three patient with postoperative bleeding (3,9%) underwent endoscopic therapy with clip positioning. Microperforation rate was 7,3% and patients were directly treated with endoclips during the procedure. No significative differences in complication rate, related to the size of the lesion and the phase of the learning curve, were found. 30-day mortality rate was 0%. In our experience result come close to the Japanese experience after an adequate training. Microperforation can be treated endoscopically during the procedure and generally don't require surgery. In western countries ESD reference centers should be created to improve technique's knowledge, spreading and training.