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Background Several studies have reported inspiring results of the ESD method treating large colorectal tumors, while the ESD method could overcome the limitations of the EMR.However, these results were inconsistent and limited by the few case number.We aim to assess the endoscopic submucosal dissection (ESD) method versus the endoscopic mucosal resection (EMR) in the treatment of large colorectal tumors (mean size ≥20 mm).