Since the original description of endoscopic excision of colorectal polyps,21 various techniques have been developed to remove large lesions, including piecemeal polypectomy, endoscopic mucosal resection, and endoscopic submucosal resection.4- 12,22- 26 The short-term success rate has been encouraging. The purpose of reviewing our experience with endoscopic excision of large colorectal lesions was not only to determine immediate outcome measures, such as technical success and the complication rate, but to conduct a comprehensive assessment of its impact beyond the index intervention. We found that most patients (83%) could be successfully treated endoscopically, with only a small number of patients (14%) requiring operative resection to treat complications, incomplete excision after index intervention, or long-term residual disease that could not be eradicated endoscopically. Furthermore, complete excision of the lesion was achieved at the index intervention, with only a few patients requiring more than 1 excision to completely eradicate the lesion. Overall, 27% of the patients required more than 1 endoscopic intervention to treat postprocedural bleeding, to remove residual disease, or to treat recurrence at the original site. We noted a 12% recurrence rate, which is within the range of 0% to 46% reported in the literature.12,22,27 Several factors have an influence on recurrence rate, including patient selection and length of follow-up. We were able to excise recurrent disease endoscopically without the need for surgical intervention. Although larger studies with longer follow-up are needed to stratify risk factors for recurrent disease, there is a lack of guidelines for the best endoscopic surveillance regimen in this heterogeneous group of large lesions. Therefore, a surveillance timeline needs to be individualized to each patient. In our practice, we currently recommend a second endoscopy at 3 to 6 months after complete excision, and we tailor the timing of additional studies according to the histologic findings and location of the lesion. Based on our results, the risk of recurrence was higher in rectal lesions, which would require a more frequent follow-up.