International consensus on the management of large (≥20 mm) colorectal laterally spreading tumors: World Endoscopy Organization Delphi study

Roupen Djinbachian^{1

2}, Douglas K Rex³, Han-Mo Chiu⁴, Norio Fukami⁵, Hiroyuki Aihara^{6

7}, Barbara A J Bastiaansen⁸, Robert Bechara⁹, Pradeep Bhandari¹⁰, Amit Bhatt¹¹, Michael J Bourke^{12

13}, Jeong-Sik Byeon¹⁴, Daniela Cardoso¹⁵, Akiko Chino¹⁶, Philip W Y Chiu¹⁷, Evelien Dekker⁸, Peter V Draganov¹⁸, Shaimaa Elkholy¹⁹, Fabian Emura^{20

21}, John Goldblum²², Amyn Haji²³, Shiaw-Hooi Ho²⁴, Yunho Jung²⁵, Hiroshi Kawachi²⁶, Mouen Khashab²⁷, Supakij Khomvilai²⁸, Eun Ran Kim²⁹, Roberta Maselli^{30

31}, Helmut Messmann³², Leon Moons³³, Yuichi Mori^{34

35}, Yukihiro Nakanishi³⁶, Saowanee Ngamruengphong²⁷, Adolfo Parra-Blanco^{37

38}, María Pellisé^{39

40}, Rafael Castilho Pinto⁴¹, Mathieu Pioche⁴², Heiko Pohl^{43

44}, Amit Rastogi⁴⁵, Alessandro Repici^{30

31}, Amrita Sethi⁴⁶, Rajvinder Singh^{47

48}, Noriko Suzuki⁴⁹, Shinji Tanaka⁵⁰, Michael Vieth⁵¹, Hironori Yamamoto⁵², Dong-Hoon Yang¹⁴, Chizu Yokoi⁵³, Yutaka Saito⁵⁴, Daniel von Renteln^{1

2}

Affiliations

¹ Montreal University Hospital Research Center, Montreal, Canada.
² Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada.
³ Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, USA.
⁴ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁵ Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, USA.
⁶ Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, USA.
⁷ Department of Medicine, Harvard Medical School, Boston, USA.
⁸ Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
⁹ Division of Gastroenterology, Kingston Health Sciences Centre, Queen's University, Kingston General Hospital, Kingston, ON, Canada.
¹⁰ Gastroenterology, Portsmouth Hospital NHS Trust, Portsmouth, UK.
¹¹ Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, USA.
¹² Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
¹³ Faculty of Medicine, University of Sydney, Sydney, Australia.
¹⁴ Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
¹⁵ Institute of Digestive Apparatus, Oncological Surgery, Goiâsnia, Brazil.
¹⁶ Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
¹⁷ Division of Upper GI Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
¹⁸ Division of Gastroenterology and Hepatology, University of Florida, Gainesville, USA.
¹⁹ Gastroenterology Division, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
²⁰ Gastroenterology Division, de La Sabana University, Chia, Colombia.
²¹ Advanced GI Endoscopy, EmuraCenter LatinoAmerica, Bogotá, Colombia.
²² Department of Anatomic Pathology, Cleveland Clinic, Cleveland, USA.
²³ King's Institute of Therapeutic Endoscopy, King's College Hospital, London, UK.
²⁴ Department of Medicine, Malaya University, Kuala Lumpur, Malaysia.
²⁵ Division of Gastroenterology, Department of Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.
²⁶ Department of Pathology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
²⁷ Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, USA.
²⁸ Surgical Endoscopy Colorectal Division, Department of Surgery Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
²⁹ Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
³⁰ Department of Biomedical Sciences, Humanitas University, Milan, Italy.
³¹ Division of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy.
³² Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany.
³³ Departments of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
³⁴ Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan.
³⁵ Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.
³⁶ Department of Pathology, Moffitt Cancer Center, Tampa, USA.
³⁷ NHR Nottingham Biomedical Research Centre, Department of Gastroenterology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
³⁸ Division of Gastroenterology, University of Nottingham, Nottingham, UK.
³⁹ Department of Gastroenterology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
⁴⁰ Hospital Clinic of Barcelona, Biomedical Research Center in Hepatic and Digestive Diseases (CIBERehd), University of Barcelona, Barcelona, Spain.
⁴¹ Endoscopic Division, Moinhos de Vento Hospital, Porto Alegre, Brazil.
⁴² Endoscopic Division, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
⁴³ Department of Gastroenterology, VA Medical Center, White River Junction, USA.
⁴⁴ Dartmouth-Hitchcock Medical Center, White River Junction, USA.
⁴⁵ Division of Gastroenterology, University of Kansas Medical Center, Kansas City, USA.
⁴⁶ Division of Digestive and Liver Disease, Columbia University Irving Medical Center, New York City, USA.
⁴⁷ Gastroenterology Unit, Division of Surgery, Northern Adelaide Local Health Area Network, Adelaide, Australia.
⁴⁸ Department of Gastroenterology, University of Adelaide, Adelaide, Australia.
⁴⁹ Wolfson Unit for Endoscopy, St. Mark's Hospital, London, UK.
⁵⁰ Gastroenterology Division, JA Onomichi General Hospital, Hiroshima, Japan.
⁵¹ Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany.
⁵² Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
⁵³ Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan.
⁵⁴ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.

PMID: 38934243
DOI: 10.1111/den.14826

International consensus on the management of large (≥20 mm) colorectal laterally spreading tumors: World Endoscopy Organization Delphi study

Roupen Djinbachian et al. Dig Endosc. 2024 Nov.

. 2024 Nov;36(11):1253-1268.

doi: 10.1111/den.14826. Epub 2024 Jun 27.

Authors

Affiliations

¹ Montreal University Hospital Research Center, Montreal, Canada.
² Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada.
³ Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, USA.
⁴ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁵ Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, USA.
⁶ Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, USA.
⁷ Department of Medicine, Harvard Medical School, Boston, USA.
⁸ Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
⁹ Division of Gastroenterology, Kingston Health Sciences Centre, Queen's University, Kingston General Hospital, Kingston, ON, Canada.
¹⁰ Gastroenterology, Portsmouth Hospital NHS Trust, Portsmouth, UK.
¹¹ Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, USA.
¹² Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
¹³ Faculty of Medicine, University of Sydney, Sydney, Australia.
¹⁴ Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
¹⁵ Institute of Digestive Apparatus, Oncological Surgery, Goiâsnia, Brazil.
¹⁶ Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
¹⁷ Division of Upper GI Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
¹⁸ Division of Gastroenterology and Hepatology, University of Florida, Gainesville, USA.
¹⁹ Gastroenterology Division, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
²⁰ Gastroenterology Division, de La Sabana University, Chia, Colombia.
²¹ Advanced GI Endoscopy, EmuraCenter LatinoAmerica, Bogotá, Colombia.
²² Department of Anatomic Pathology, Cleveland Clinic, Cleveland, USA.
²³ King's Institute of Therapeutic Endoscopy, King's College Hospital, London, UK.
²⁴ Department of Medicine, Malaya University, Kuala Lumpur, Malaysia.
²⁵ Division of Gastroenterology, Department of Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.
²⁶ Department of Pathology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
²⁷ Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, USA.
²⁸ Surgical Endoscopy Colorectal Division, Department of Surgery Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
²⁹ Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
³⁰ Department of Biomedical Sciences, Humanitas University, Milan, Italy.
³¹ Division of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy.
³² Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany.
³³ Departments of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
³⁴ Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan.
³⁵ Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.
³⁶ Department of Pathology, Moffitt Cancer Center, Tampa, USA.
³⁷ NHR Nottingham Biomedical Research Centre, Department of Gastroenterology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
³⁸ Division of Gastroenterology, University of Nottingham, Nottingham, UK.
³⁹ Department of Gastroenterology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
⁴⁰ Hospital Clinic of Barcelona, Biomedical Research Center in Hepatic and Digestive Diseases (CIBERehd), University of Barcelona, Barcelona, Spain.
⁴¹ Endoscopic Division, Moinhos de Vento Hospital, Porto Alegre, Brazil.
⁴² Endoscopic Division, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
⁴³ Department of Gastroenterology, VA Medical Center, White River Junction, USA.
⁴⁴ Dartmouth-Hitchcock Medical Center, White River Junction, USA.
⁴⁵ Division of Gastroenterology, University of Kansas Medical Center, Kansas City, USA.
⁴⁶ Division of Digestive and Liver Disease, Columbia University Irving Medical Center, New York City, USA.
⁴⁷ Gastroenterology Unit, Division of Surgery, Northern Adelaide Local Health Area Network, Adelaide, Australia.
⁴⁸ Department of Gastroenterology, University of Adelaide, Adelaide, Australia.
⁴⁹ Wolfson Unit for Endoscopy, St. Mark's Hospital, London, UK.
⁵⁰ Gastroenterology Division, JA Onomichi General Hospital, Hiroshima, Japan.
⁵¹ Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany.
⁵² Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
⁵³ Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan.
⁵⁴ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.

PMID: 38934243
DOI: 10.1111/den.14826

Abstract

Objectives: There have been significant advances in the management of large (≥20 mm) laterally spreading tumors (LSTs) or nonpedunculated colorectal polyps; however, there is a lack of clear consensus on the management of these lesions with significant geographic variability especially between Eastern and Western paradigms. We aimed to provide an international consensus to better guide management and attempt to homogenize practices.

Methods: Two experts in interventional endoscopy spearheaded an evidence-based Delphi study on behalf of the World Endoscopy Organization Colorectal Cancer Screening Committee. A steering committee comprising six members devised 51 statements, and 43 experts from 18 countries on six continents participated in a three-round voting process. The Grading of Recommendations, Assessment, Development and Evaluations tool was used to assess evidence quality and recommendation strength. Consensus was defined as ≥80% agreement (strongly agree or agree) on a 5-point Likert scale.

Results: Forty-two statements reached consensus after three rounds of voting. Recommendations included: three statements on training and competency; 10 statements on preresection evaluation, including optical diagnosis, classification, and staging of LSTs; 14 statements on endoscopic resection indications and technique, including statements on en bloc and piecemeal resection decision-making; seven statements on postresection evaluation; and eight statements on postresection care.

Conclusions: An international expert consensus based on the current available evidence has been developed to guide the evaluation, resection, and follow-up of LSTs. This may provide guiding principles for the global management of these lesions and standardize current practices.

Keywords: Endoscopic resection; Endoscopic submucosal dissection; Endoscopy, Endoscopic mucosal resection; Gastrointestinal cancer; Neoplasia.

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References

REFERENCES

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1. van Hattem WA, Shahidi N, Vosko S et al. Piecemeal cold snare polypectomy versus conventional endoscopic mucosal resection for large sessile serrated lesions: A retrospective comparison across two successive periods. Gut 2021; 70: 1691–1697.
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International consensus on the management of large (≥20 mm) colorectal laterally spreading tumors: World Endoscopy Organization Delphi study

Affiliations

International consensus on the management of large (≥20 mm) colorectal laterally spreading tumors: World Endoscopy Organization Delphi study

Authors

Affiliations

Abstract

References

REFERENCES

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Research Materials