Objective To investigate the clinical effect of endoscopic mucosal resection (EMR) for elderly patients with colorectal sessile protuberant lesions. Methods A total of 78 elderly patients, aged 50 to 78 (63.4±9.2)years, ranging from with colorectal sessile protuberant lesions verified by colonoscopy in our hospital from January 2015 to January 2017 were enrolled in this study. All of them underwent EMR. Size and morphology of lesions, operation methods, complications, and pathological types were investigated. The patients were followed up for at least 3 months. Results There were 72 cases receiving EMR, and 3 cases of type Ⅱa+Ⅱc and 3 cases of laterally spreading tumors (LSTs) undergoing endoscopy piecemeal mucosal resection (EPMR). Eight cases experienced intra-operative bleeding, with an amount of less than 20 ml. No delayed bleeding or perforation occurred. The lesions were completely resected with an enbloc resection rate of 92.3% (72/78), and the histological curative resection rate was 91% (71/78). Post-operative histopathology confirmed that there were 8 cases (10.3%) of hyperplastic polyp, 58 cases (74.3%) of tubular adenoma or tubular villous adenoma with low-grade dysplasia (LGD) and 10 cases (12.8%) with high-grade dysplasia (HGD), and 2 cases (2.6%) of submucosal carcinoma. No tumor residual or recurrence was found during the follow-up of 12 (3-24) months among the 68 followed patients. Conclusion EMR is safe and effective in treatment of colorectal sessile protuberant lesions in the elderly, and should be promoted in clinical practice.