Introduction: Endoscopic mucosal resection (EMR) of large non-pedunculated colorectal lesions (≥20 mm) with a GSEED-RE2 score ≥4 carries a high risk of delayed bleeding, even when prophylactic clip closure is performed. Covergel is a thermosensitive biogel specifically designed to protect mucosal defects and enhance healing.

Case description: We report four high-risk cases treated with EMR plus preventive Covergel application: Case 1, 81-year-old male, 30-mm 0-Is cecal lesion (7 points); Case 2, 80-year-old male, 40-mm 0-II-Gnh splenic flexure lesion (6 points); Case 3, 57-year-old male, 45-mm 0-Is sigmoid lesion (6 points); Case 4, 59-year-old male, 40-mm 0-IIa-NG cecal lesion (6 points).

Conclusions: No delayed bleeding or adverse events occurred, suggesting Covergel as a promising adjunct to prevent post-EMR hemorrhage in high-risk lesions.