Colonoscopy and polypectomy reduces the anticipated incidence of colorectal malignancy in patients with significant adenomatous polyps by approximately 80% in long term follow up. Most endoscopists routinely perform removal of small polyps. However, removal of flat colonic neoplasia 20mm in size or larger is more complex and requires specific endoscopic techniques, one such technique being termed wide field endoscopic mucosal resection (WF-EMR). Traditionally these lesions were treated surgically at significant expense to the healthcare system. Endoscopic treatment of large colonic polyps reduces health care costs by approximately $11,000 per patient treated, saves bed days and avoids surgery in more than 90% of patients.