Large colorectal laterally spreading tumors (LSTs) ≥20 mm are immediate precursors to colorectal cancer (CRC). There are many perceived diverging paradigms on the optimal management of these lesions to prevent recurrence, eventual development of cancer, and metastasis, morbidity, and mortality. There have been significant advances in the management of these lesions, with novel resection techniques, increased uptake of en bloc resection methods in the Western world, and improved training. There is, however, a lack of clear consensus on the management of large nonpedunculated colorectal polyps, with significant geographic variability between Eastern and Western paradigms. Opinions surrounding training requirements, the use of chromoendoscopy, the selection of appropriate lesions for piecemeal resection, and appropriate follow-up remain controversial with a lack of a unified worldwide systematic approach. Two experts in interventional endoscopy spearheaded an evidence-based Delphi study on behalf of the World Endoscopy Organization Colorectal Cancer Screening Committee to spearhead an international consensus to better guide management and attempt to homogenize practices.
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