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

Djinbachian R, Rex DK, Chiu HM, Fukami N, Aihara H, Bastiaansen BA, Bechara R, Bhandari P, Bhatt A, Bourke MJ, Byeon JS, Cardoso D, Chino A, Chiu PW, Dekker E, Draganov PV, Elkholy S, Emura F, Goldblum J, Haji A, Ho SH, Jung Y, Kawachi H, Khashab M, Khomvilai S, Kim ER, Maselli R, Messmann H, Moons L, Mori Y, Nakanishi Y, Ngamruengphong S, Parra-Blanco A, Pellisé M, Pinto RC, Pioche M, Pohl H, Rastogi A, Repici A, Sethi A, Singh R, Suzuki N, Tanaka S, Vieth M, Yamamoto H, Yang DH, Yokoi C, Saito Y, von Renteln D (2024)

Publication Language: English

Publication Type: Journal article

Publication year: 2024

Journal

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.

Authors with CRIS profile

Involved external institutions

Cleveland Clinic United States (USA) (US) King's College Hospital (KCH) United Kingdom (GB) Soonchunhyang University (SCH) / 순천향대학교 Korea, Republic of (KR) University of Malaya (UM) / Universiti Malaya Malaysia (MY) The Cancer Institute Hospital / がん研有明病院 Japan (JP) St. Mark's Hospital United Kingdom (GB) Centre hospitalier de l'Université de Montréal (CHUM) Canada (CA) Indiana University – Purdue University Indianapolis United States (USA) (US) JA Onomichi General Hospital Japan (JP) Johns Hopkins University (JHU) United States (USA) (US) National Taiwan University Hospital (NTUH) / 國立台灣大學醫學院附設醫院 Taiwan (TW) Jichi Medical University / 自治医科大学 Japan (JP) Chulalongkorn University / จุฬาลงกรณ์มหาวิทยาลัย Thailand (TH) Asan Medical Center / 서울아산병원 Korea, Republic of (KR) Brigham and Women's Hospital (BWH) United States (USA) (US) Sungkyunkwan University (SKKU) Korea, Republic of (KR) National Center for Global Health and Medicine (NCGM) Japan (JP) Humanitas University Italy (IT) National Cancer Center Hospital Japan (JP) Portsmouth Hospitals NHS Trust United Kingdom (GB) Universitätsklinikum Augsburg Germany (DE) Westmead Hospital Australia (AU) University Medical Centre Utrecht (UMC Utrecht) Netherlands (NL) Showa University Hospitals Japan (JP) H. Lee Moffitt Cancer Center & Research Institute United States (USA) (US) The Chinese University of Hong Kong (CUHK) China (CN) Amsterdam University Medical Centers (Amsterdam UMC) / Amsterdam Universitair Medische Centra Netherlands (NL) Nottingham Biomedical Research Centre United Kingdom (GB) University of Florida United States (USA) (US) Hospital Clínic de Barcelona Spain (ES) Hospital Moinhos de Vento Brazil (BR) Cairo University Egypt (EG) Universidad de La Sabana Colombia (CO) Hôpital Edouard Herriot France (FR) University of Kansas Medical Center United States (USA) (US) Columbia University Irving Medical Center (CUIMC) United States (USA) (US) Northern Adelaide Local Health Network Australia (AU) Mayo Clinic in Arizona United States (USA) (US) White River Junction VA Medical Center United States (USA) (US) Queen's University Canada (CA)

How to cite

APA:

Djinbachian, R., Rex, D.K., Chiu, H.M., Fukami, N., Aihara, H., Bastiaansen, B.A.,... von Renteln, D. (2024). International consensus on the management of large (≥20 mm) colorectal laterally spreading tumors: World Endoscopy Organization Delphi study. Digestive Endoscopy. https://doi.org/10.1111/den.14826

MLA:

Djinbachian, Roupen, et al. "International consensus on the management of large (≥20 mm) colorectal laterally spreading tumors: World Endoscopy Organization Delphi study." Digestive Endoscopy (2024).

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