Cold EMR, hot EMR or ESD for large benign adenoma: not one size fits all

We read with great interest the study by O’Sullivan et al ,1 examining the technical and procedural outcomes of Cold Endoscopic Mucosal Resection (C-EMR) versus Hot EMR (H-EMR). We congratulate the authors for conducting this important research, which adds valuable information to the body of knowledge guiding our choice of the optimal treatment modality for large, benign colorectal polyps. However, we would like to address several points. First, readers should be aware that this study focuses on a highly selected group of large non-pedunculated colon polyps (LNPCPs) as only 20% of referred lesions during the study period of 4 years met the inclusion criteria, being flat lesions of 15–50 mm, without macronodule, depressed area or optical suspicion of submucosal invasive cancer (SMIC). Despite this selection, 2.2% unrecognised SMIC was found, …