International consensus on the management of large (≥20 mm) colorectal laterally spreading tumors: World Endoscopy Organization Delphi study
Roupen Djinbachian, Douglas K. Rex, Han‐Mo Chiu, Norio Fukami, Hiroyuki Aihara, Barbara A.J. Bastiaansen, Robert Bechara, Pradeep Bhandari, Amit Bhatt, Michael J. Bourke, Jeong‐Sik Byeon, Daniela Cardoso, Akiko Chino, Philip Wai Yan Chiu, Evelien Dekker, Peter V. Draganov, Shaimaa Elkholy, Fabián Emura, John R. Goldblum, Amyn Haji, Shiaw Hooi Ho, Yunho Jung, Hiroshi Kawachi, Mouen A. Khashab, Supakij Khomvilai, Eun Ran Kim, Roberta Maselli, Helmut Messmann, Leon M.G. Moons, Yuichi Mori, Yukihiro Nakanishi, Saowanee Ngamruengphong, Adolfo Parra‐Blanco, María Pellisé, Rafael Castilho Pinto, Mathieu Pioche, Heiko Pohl, Amit Rastogi, Alessandro Repici, Amrita Sethi, Rajvinder Singh, Noriko Suzuki, Shinji Tanaka, Michael Vieth, Hironori Yamamoto, Dong‐Hoon Yang, Chizu Yokoi, Yutaka Saito, Daniel von Renteln
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.