Overview

The goal of this randomized clinical trial is to learn if a combination of hot and cold EMR technique is associated with a lower risk of polyp recurrence without increasing the risk of complication when removing large polyps.

Participants will undergo EMR and return for a follow-up endoscopy in 3-6 months to check for polyp recurrence.

Eligibility

Inclusion Criteria:

• Adult patient (age 18 years or older)
• Polyp size of at least 20 mm
• - Morphology: Flat or superficially raised polyp morphology (i.e., Paris classification 1s, 0-IIa or 0-IIb, or a combination of the above)

Exclusion Criteria:

• Polyps with previous failed resection attempts or polyp recurrence
• Suspected deep submucosal invasion on endoscopic assessment of surface mucosal pit pattern (Kudo V or NICE 3 pattern) or histologically confirmed malignancy (invasive adenocarcinoma)
• Polyps with nodules too large (>1-1.5cm) for the use of a cold snare
• Inflammatory bowel disease