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Polyp size measurements are important for polyp risk stratification, choice of polypectomy technique and follow-up interval decisions. We present the first clinical experience of measuring colorectal polyp size during live colonoscopies using a new endoscope with a laser-based size measurement function (virtual scale endoscope, VSE). VSE superimposes a virtual linear or circular ruler onto objects in the endoscopist’s field of view. A total of 59 patients were enrolled and visual, VSE and reference size measurement obtained in 36 polyps up to 20 mm. When using VSE, we found higher relative accuracy for polyp size measurements (85.4%) compared with visual size estimation (66.8%; p< 0.001) as compared with polyp size measurement after removal. When looking at the percentage of size measurements that were within 25% of true size (as compared with polyp size measurement after removal), we found that …