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Outcomes of Endoscopic Mucosal Resection for Large Sessile Polyps and LST of Colorectum Dae Hwan Kang, Hyung Wook Kim*, Cheol Woong Choi, Su Bum Park, Young Mi Hong, Jong Kun Ha, Ji Hoon Yoon, Min Dae Kim Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea; Internal Medicine, Bongseng Memorial Hospital, Busan, Republic of Korea Backgrounds and Aims: Recently, endoscopic submucosal dissection (ESD) developed as a procedure for en bloc removal of colorectal neoplastic lesions regardless of their localization or diameter. However, the ESD procedures are technically difficult and associated with more complication compared to conventional endoscopic mucosal resection (EMR). The aim of our study is to assess efficacy and safety of endoscopic resection techniques to remove large( 20mm in diameter) sessile polyps and Laterally spreading tumor. Methods: We have treated 66 large sessile polyp and laterally spreading tumors which were resected by endoscopically from February 2009 to March 2011. Among them 48 lesions were laterally spreading tumors (LSTs) and 18 lesions were sessile polyps over 20mm in diameter. We compared the rate of en bloc resection, residual tumor/recurrence and complications between EMR and ESD. Result: 66 patients were included (age: 61.4 11.4(30-82). M:41, F: 25). There were high incidence of advanced pathology (adenocarcinoma 30.3%, high grade dysplasia 36.4%) The number of patients allocated in EMR, EMR-P, ESD-S and only ESD were 9(13.6%), 41(62.1%), 9(13.6%), 7(10.6%) respectively. Overall en bloc resection rate was 50.0%(33/66) and en bloc resection rate appeared to be more observed in ESD group than other groups, but there were not significant differences (EMR 66.7%, EMR-P 43.9%, ESD-S 33.3%, ESD 85.7%, p 0.105). Perforation occurred in 3(4.5%)cases. During follow-up period, there was only 1(1.5%) recurrence Conclusion: Patients with large ( 20mm in diameter) sessile polyps and laterally spreading tumor have a high incidence of advanced pathology, but most of large colorectal neoplasia can be treated by conventional EMR technique. EMR methods with good feasibility may take a transitional role before initiating ESD method in the treatment of large colorectal neoplasia