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Background EMR has been well accepted as one of the management options for superficial colorectal tumours requiring minimal invasion, better patient tolerance and significantly lower morbidity compared to surgery. However, lesions≥20 mm can be tricky. Method Retrospective medical record analysis was performed for a period of 24 months between Jan 2015 – Dec 2016. The data was collected on patient demographics, polyp characteristics, complications and follow up endoscopy at the 3 months and 12 months intervals where applicable. Results A total of 212 patients had 264 procedures. The mean age of the population was 68. All of the procedures were performed by experienced endoscopists using hot/cold snare and Methylene blue/Volplex solution. 22 (8%) of all polypectomies were ≥40 mm in size. The rate of complications in accordance with polyp size and colonic sites are illustrated below (table 1 and 2). The perforation was managed with endoclips and required a day of admission. The immediate bleeding had been managed with clipping ±adrenaline injection. The overall 30 days mortality was zero. 9 (4%) patients had prophylactic endoclips. The adenocarcinoma detection rate was 2.8% (6) and all of them had had either repeat scope at the 3 and 12 months intervals or had surgery. 12 (5.6%) had tubular/tubulovillous adenoma with high grade dysplasia. 8 (66%) of these patients had repeat scope at 3 months, whilst 1 (8%) underwent surgery and 3 (25%) made an informed choice to not have further colonoscopic examination. Our rescope rate for the polyp size ≥20 mm at 3 months and 12 months was 69% and 78% respectively. The main reasons for not having the scope were either patient choice or having surgery/other forms of cancer treatment. Conclusions EMR is an effective and safe approach in the expert hands for the management of colonic polyps. The role of prophylactic endoclips is still unclear in reducing the risk of post-procedural bleeding and it is highly dependent on the operator’s preference and experience. Total character count 2817.