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

Author:

Djinbachian Roupen12,Rex Douglas K.3,Chiu Han‐Mo4,Fukami Norio5,Aihara Hiroyuki67,Bastiaansen Barbara A. J.8,Bechara Robert9,Bhandari Pradeep10,Bhatt Amit11,Bourke Michael J.1213,Byeon Jeong‐Sik14,Cardoso Daniela15,Chino Akiko16ORCID,Chiu Philip W. Y.17ORCID,Dekker Evelien8,Draganov Peter V.18,Elkholy Shaimaa19ORCID,Emura Fabian2021,Goldblum John22,Haji Amyn23,Ho Shiaw‐Hooi24,Jung Yunho25,Kawachi Hiroshi26ORCID,Khashab Mouen27,Khomvilai Supakij28,Kim Eun Ran29,Maselli Roberta3031,Messmann Helmut32,Moons Leon33,Mori Yuichi3435,Nakanishi Yukihiro36,Ngamruengphong Saowanee27,Parra‐Blanco Adolfo3738,Pellisé María3940,Pinto Rafael Castilho41,Pioche Mathieu42,Pohl Heiko4344,Rastogi Amit45,Repici Alessandro3031,Sethi Amrita46,Singh Rajvinder4748,Suzuki Noriko49,Tanaka Shinji50,Vieth Michael51,Yamamoto Hironori52ORCID,Yang Dong‐Hoon14ORCID,Yokoi Chizu53,Saito Yutaka54ORCID,von Renteln Daniel12

Affiliation:

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

Abstract

ObjectivesThere 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.MethodsTwo 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.ResultsForty‐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.ConclusionsAn 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.

Publisher

Wiley

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