Barendse RM, et al. - The physicians performed this randomised controlled trial to compare the clinical outcome and cost-effectiveness of transanal endoscopic microsurgery (TEM) vs. endoscopic mucosal resection (EMR) for large rectal adenomas. Non-inferiority of EMR could not be described under the statistical assumptions of this study. However, because of a tendency of lower complication rates and a better cost-effectiveness ratio, EMR could have potential as the primary method of choice. The high rate of unexpected cancers needed to be dealt with in further studies.