A colon polyp that presents as a laterally spreading tumor (LST) of the colorectum requires careful endoscopic characterisation before resection planning. The LST subtype — defined by its surface morphology — is the central factor that drives the choice of technique.
This protocol addresses patients with a laterally spreading tumor (LST) of the colorectum. LSTs grow predominantly laterally along the bowel wall and are classified into subtypes (granular and non-granular, with further morphologic distinctions). Magnifying endoscopy and endoscopic ultrasonography are used as appropriate to establish the subtype and guide treatment selection.
Endoscopic resection is the cornerstone, with the specific technique — en bloc or piecemeal — selected according to the LST subtype. The full subtype-by-subtype decision framework is available in the complete protocol.
The choice of treatment between ESD and piecemeal EMR for a large laterally spreading tumor (LST) should be based on the subtype of LST with use of magnifying endoscopy and endoscopic ultrasonography as appropriate (recommendation strong [agreement rate 100%], level of evidence C).
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