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Early surveillance colonoscopy (SC) after colorectal endoscopic submucosal dissection (ESD) is widely recommended, despite limited evidence for benign lesions resected en bloc with negative margins. In this large international Western cohort of 708 patients with benign colorectal lesions treated by ESD and at least one follow-up colonoscopy, metachronous advanced neoplasia was uncommon (6.9%), local recurrence was rare (1.6%) and no cancer arose from the resection scar. Delaying the first surveillance colonoscopy beyond 24 months (16% of cases, comparable to the early cases) was not associated with a higher risk of advanced neoplasia. The only independent predictor was the number of synchronous adenomas at index colonoscopy. These findings suggest that routine early surveillance after R0 ESD could be reconsidered for most patients.