| Summary: | Laterally spreading tumors (LST) have become a recognizable proportion of all pre-cancerous colorectal lesions, particularly with the advent of population-based bowel cancer screening. Since Kudo’s first description in 1993 which analyzed how best to remove flat and depressed types of early colorectal cancer via endoscopic mucosal resection (EMR), there has been much debate as to the definition of these lesions and how they should be excised [1]. The 2002 Paris Consensus established boundaries of LST morphology. EMR is currently the mainstream technique for treating LST, but debate has emerged as to whether especially piecemeal EMR should be replaced by newer modalities such as endoscopic submucosal dissection (ESD) [2]. A key point is that en-bloc resection with EMR is usually limited to lesions < 20 mm diameter in the colon or < 25 mm in the rectum [3]. Although piecemeal EMR has proven to be a reliable option, this may come with reduced cost-effectiveness over the entire treatment course for the lesion, less good pathological assessment, and increased risks of local recurrence. Because of this, a substantial body of opinion suggests that ESD should be the future in LST treatment. However, when considering ESD as “gold standard,” we cannot overlook its downsides of technical intricacy, prolonged time of procedure and increased chances of perforation and overnight hospital admission.
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