Efficacy, Safety and Recurrence After Cold-EMR Plus APC for Large Colonic Lesions

Inclusion Criteria: * All patients aged ≧ 18 years undergoing colonoscopy for any indication (screening, anemia, surveillance, or scheduled to undergo endoscopic mucosal resection) * Lesions of 20 mm and larger. * All colonic lesions removed using COLD-EMR technique, presenting both adenomatous (Kudo IIIL/IIIS pit pattern) * Patients who were able to provide written informed consent Exclusion Criteria: * Suspected lesions for submucosal invasion (e.g., Kudo V or Paris 0-IIa-IIc with non-granular surface) * Lesions with a wide Paris 0-Is component (\>10mm) that could increase the risk of submucosal invasion and could limit the mechanical cutting of the snare * Pedunculated polyps * Active/quiescent colitis * Rectal lesions * Residual or recurrent adenoma after endoscopic mucosal resection