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One patient had a small lesion on follow-up 3 months after ESD that was removed by a curative EMR. There were no immediate or delayed adverse events. ESD can be used to resect squamous cell carcinoma in situ of the anal canal. Larger studies with long-term follow-up are needed to evaluate the role of ESD in early squamous cell anal cancer and to compare it with other modalities of treatment. ESD can be used to resect squamous cell carcinoma in situ of the anal canal. Larger studies with long-term follow-up are needed to evaluate the role