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or sessile lesions with lateral extension exceeding 1 cm. This term is generally used for superficial adenomas or adenocarcinomas, but very rarely for supracentimetric sessile serrated lesions or ulcerated invasive adenocarcinomas. There is still a very active debate in the endoscopic community about the best choice of technique for resecting superficial neoplasias with negligible risk of metastatic lymph node evolution (intramucosal or superficial submucosal adenocarcinoma without vascular or lymphatic embols, without budding and not undifferentiated). Some defend piece meal endoscopic mucosal resection (EMR), which allows the lesions to be resected in several fragments with a diathermic snare and others, including ourselves, defend endoscopic submucosal dissection (ESD), which most often allows removal of a single piece with safety margins using a dissection knife. Endoscopic prediction of histology is far from an exact science and even Japanese experts predict only a statistical risk of invasive cancer within a lesion based on its endoscopic characteristics [1–3]. For example, this risk is almost 50% for pseudodepressed non-granular LSTs, nearly 20% for granular LSTs with a macronodule, and risk remains quite low (<3%) for homogeneous granular LSTs without any macronodule. In addition, degeneration of LST is not at all homogeneous and there can sometimes be a very small outbreak of invasive cancer within a large lesion, most of which is adenomatous. Because it is impossible to predict with certainty which lesion will contain invasive or noninvasive cancer, it is still essential today to choose the resection technique a priori, by assessing a benefit-risk ratio. Finally, only the report of histological analysis allows us to decide in a multidisciplinary meeting if resection can be considered curative. However, to rely on that report, we must ensure that it is high quality, and it can only be thorough if the part has been seen in its entirety. That is, it must be in a single piece, oriented, and with lateral and deep safety margins to confirm that resection is complete. Presence of a single vascular embol in a tumor that superficially invades the submucosa is associated with a 5 to 10 times greater risk [4–6] of lymph node metastases developing. How can we still risk missing this embol in 2019 under the pretext that the best technique takes a little longer than the reference technique that cured the majority of patients? Some argue that risk of perforation of dissection (3–5%) [7] is higher than that for piecemeal EMR (1–3%) [8], but that needs to be verified with the new generation who have performed more dissections than piecemeal EMR, unlike experts who authored literature a few years ago and who compared years of experience in EMR with a low experience in ESD. In addition, can we still talk about complications when more than 95% of these perforations are closed with clips and do not lead to surgery [9, 10]? These diminutive perforations have most often become adverse events without consequence; on the other hand, if an embolus, a budding or focal invasion has been missed because the fragment in question has not been recovered, there will be dramatic consequences for the patient, who will not then benefit from the complementary surgery recommended for permanent healing. Of course these situations are rare and studies to demonstrating outcomes of dissection in terms of survival would require huge numbers of people. However, ESD is now accessible outside Japan and in the colon, facilitated by traction techniques [11]. Therefore, it is no longer possible to consider the technique restricted to use in research Colorectal endoscopic submucosal dissection for all LSTs: histological information loss due to piecemeal EMR is no longer acceptable