AIM: To examine the efficacy and complications of colonoscopic resection of colorectal polypoid lesions.METHODS: We retrospectively reviewed 1354 polypectomies performed on 1038 patients over a tenyear period. One hundred and sixty of these were performed for large polyps, those measuring ≥ 20 mm.Size, shape, location, histology, the technique of polypectomy used, complications, drugs assumption andassociated intestinal or extra intestinal diseases wereanalyzed. For statistical analysis, the Pearson χ2 test,NPC test and a Binary Logistic Regression were used.RESULTS: The mean patient age was 65.9±12.4 years,with 671 men and 367 women. The mean size of polyps removed was 9.45±9.56 mm while the size of large polyps was 31.5:1:10.8 mm. There were 388 pedunculated and 966 sessile polyps and the most common location was the sigmoid colon (41.3%). The most frequent histology was tubular adenoma (55.9%)while for the large polyps was villous (92/160 -57.5%).Coexistent malignancy was observed in 28 polyps (2.1%)and of these, 20 were large polyps. There were 17procedural bleeding (1.3%) and one perforation. The statistical analysis showed that cancer is correlated to polyp size (P < 0.0001); sessile shape (P < 0.0001) and bleeding are correlated to cardiac disease (P=0.034),tubular adenoma (P=0.016) and polyp size.CONCLUSION: The endoscopic resection is a simple and safe procedure for removing colon rectal neoplastic lesions and should be considered the treatment of choice for large colorectal polyps. The polyp size is an importantrisk factor for malignancy and for bleeding.