Objective This study aimed to retrospectively analyze the real-world practices of resecting colorectal polyps of varying sizes using cold forcep polypectomy (CFP), cold snare polypectomy (CSP), and endoscopic mucosal resection (EMR). Methods A total of 12,290 nonpedunculated colorectal polyps measuring ≤ 19 mm in length (from 10,295 patients) were enrolled from January 2022 to December 2023. Polypectomy was conducted by 30 endoscopists. The polyps were categorized into three groups based on size: 1~5 mm, >5~10 mm and >10~19 mm, to compare the polypectomy methods utilized in each group. The subgroup analysis was performed to examine the use of hemostatic clips in CSP for >5~10 mm polyps and the changes in resection methods between 2022 and 2023. Results CFP (6,769 polyps, 81.7%) was the predominant method for resecting 1~5 mm sessile polyps (8,289 polyps). For polyps sized >5~10 mm (2,455 polyps), CSP was used most frequently (1,372, 55.9%), although its utilization varied significantly among physicians (median 52.9%, quartile 40.3%, 60.0%). EMR (1,349 poolyps, 87.3%) was the main technique for >10~19 mm sessile polyps. The rate of CSP usage in nonpedunculated polypectomy for polyps larger than 5 to 10 mm significantly increased from 45.7% (503/1101) in 2022 to 64.2% (869/1354) in 2023. The frequency of using clip in CSP for >5~10 mm sessile polyps was 40.1% (550/1372) overall, demonstrating notable variability among different endoscopists (median 48.3%, quartile 29.8, 67.9%). Conclusion Significant differences exist in the resection methods for sessile polyps measuring ≤ 19 mm among endoscopists. CFP is primarily utilized for polyps between 1 and 5 mm. For polyps ranging from >5 to 10 mm, CSP is predominantly employed, with its annually usage rate increasing. In the case of polyps larger than 10 mm and up to 19 mm, EMR is the main approach. Additionally, notable variations in the use of metal clips during CSP are observed among different physicians.