Abstract：
OBJECTIVE: 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.
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.
摘要：
目的：在处理大的（≥20mm）侧向扩散的肿瘤（LSTs）或非带蒂的结直肠息肉方面取得了重大进展；然而，对于这些具有显著地理差异的病变的处理缺乏明确的共识,尤其是在东西方范式之间.我们旨在提供国际共识，以更好地指导管理并尝试使实践同质化。
方法：两位介入内镜专家代表世界内镜组织结直肠癌筛查委员会率先开展了一项基于证据的Delphi研究。由六名成员组成的指导委员会制定了51项声明，来自六大洲18个国家的43名专家参加了三轮投票。建议的分级，评估,开发和评估工具用于评估证据质量和推荐强度。共识被定义为在5点李克特量表上≥80％的同意（强烈同意或同意）。
结果：42项声明经过三轮投票达成共识。建议包括：关于培训和能力的三份声明；关于切除前评估的10份声明，包括光学诊断，分类，LSTs的分期；关于内镜切除适应症和技术的14项声明，包括关于整体和零碎切除决策的声明；关于切除后评估的七个声明；关于切除后护理的八个声明。
结论：已根据现有证据制定了国际专家共识，以指导评估，切除,以及LST的后续行动。这可以为这些病变的全球管理提供指导原则，并规范当前的实践。
方法：两位介入内镜专家代表世界内镜组织结直肠癌筛查委员会率先开展了一项基于证据的Delphi研究。由六名成员组成的指导委员会制定了51项声明，来自六大洲18个国家的43名专家参加了三轮投票。建议的分级，评估,开发和评估工具用于评估证据质量和推荐强度。共识被定义为在5点李克特量表上≥80％的同意（强烈同意或同意）。
结果：42项声明经过三轮投票达成共识。建议包括：关于培训和能力的三份声明；关于切除前评估的10份声明，包括光学诊断，分类，LSTs的分期；关于内镜切除适应症和技术的14项声明，包括关于整体和零碎切除决策的声明；关于切除后评估的七个声明；关于切除后护理的八个声明。
结论：已根据现有证据制定了国际专家共识，以指导评估，切除,以及LST的后续行动。这可以为这些病变的全球管理提供指导原则，并规范当前的实践。
