Background and Study Aims: Several endoscopic techniques have been developed t o prevent bleeding after the removal of large pedunculated polyps. Patients and Methods: From January 1995 to December 2002, 488 consecutive patients with pedun culated colorectal polyps, the heads of which were larger than 10 mm in diameter , were randomly assigned to three groups. In group A (163 patients), detachable snares were placed at the base of the stalk and standard snares were then used f or polypectomy. In group B (161 patients), the polyp stalk was injected with a 0 .01%epinephrine solution before conventional snare polypectomy. Group C (a cont rol group including 164 patients) underwent conventional snare polypectomy witho ut preventive measures. Early (< 24 h) and late (> 24 h-30 days) bleeding compl ications were assessed. Each group was divided into two subgroups relative to th e polyp size (polyps 1.0-1.9 cm and polyps ≥2 cm). Results: Overall bleeding c omplications occurred after 4.3%of the polypectomies. Bleeding was successfully controlled in all patients, and no blood transfusions were required. There were three cases of bleeding in group A (1.8%), five in group B (3.1%), and 13 in group C (7.9%). Early bleeding was more frequent than late bleeding (15 vs. six patients). In polyps ≥2 cm (207 patients), postpolypectomy bleeding occurred i n 14 patients (6.7%): two (2.7%) in the detachable snare group, two (2.9%) in the epinephrine injection group, and 10 (15.1%) in the control group. Conclusi ons: These results show that polypectomy of large pedunculated polyps is associa ted with a higher incidence of bleeding. Particularly in polyps larger than 2 cm , preventive measures can significantly reduce bleeding complications after poly pectomy. This can be achieved with similar efficacy either by placing Endoloops or by injecting epinephrine. Background and Study Aims: Several endoscopic techniques have been developed to prevent bleeding after the removal of large pedunculated polyps. Patients and Methods: From January 1995 to December 2002, 488 consecutive patients with pedun culated colorectal polyps, the heads of which were larger than 10 In group A (163 patients), detachable snares were placed at the base of the stalk and standard snares were then used f or polypectomy. In group B (161 patients), the polyp stalk Group C (a cont rol group including 164 patients) underwent conventional snare polypectomy with uthotropic measures. Early (<24 h) and late (> 24 h-30 days Each group was divided into two subgroups relative to th e polyp size (polyps 1.0-1.9 cm and polyps ≥ 2 cm). Results: Overall bleeding c omplications occurred after 4.3% of The polypectomies. Bleeding was successfully controlled in all patients, and no blood transfusions were required. There were three cases of bleeding in group A (1.8%), five in group B (3.1%), and 13 in group C In polyps ≥ 2 cm (207 patients), postpolypectomy for bleeding occurred in 14 patients (6.7%): two (2.7%) in the detachable snare group, two (2.9%) in the epinephrine injection group, and 10 (15.1%) in the control group. Conclusi ons: These results show that polypectomy of large pedunculated polyps is associa ted with a higher incidence of bleeding. Particularly in polyps larger than 2 cm , preventive measures can significantly reduce bleeding complications after poly pectomy. This can be with similar efficacy either by placing endoloops or by injecting epinephrine.