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Da-Huan Li,1,* Xue-Ying Liu,1,* Chao Huang,2 Chao-Nan Deng,3 Jia-Lu Zhang,1 Xiao-Wen Xu,1 Liang-Bi Xu1 1Department of the Digestive Endoscopy, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550000, People’s Republic of China; 2Department of the Emergency, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550000, People’s Republic of China; 3Department of the Pathology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Liang-Bi XuDepartment of the Digestive Endoscopy, The Affiliated Hospital of Guizhou Medical University, No. 28 of Guiyi Street, Yunyan District, Guiyang, 550000, People’s Republic of ChinaTel +8615685178740Fax +86085186774297Email xuliangbi88_dr@163.comObjective: This study aims to analyze the endoscopic and pathological characteristics of colorectal laterally spreading tumors (LSTs) to assist malignant risk stratification to inform selection of the appropriate treatment strategy.Methods: Patients with colorectal LST were selected as retrospective study objects. Characteristics, including endoscopic findings and the most common site of LSTs of different diameters and histological types, were analyzed. The risk factors for malignancy in colorectal LST were explored by multivariate logistic regression analysis.Results: LSTs with diameters of ≥ 20 mm were found mainly in the rectum and mainly with granular-mixed (G-M) morphology (36% and 44.6%, respectively; p < 0.05), while LSTs with diameters of < 20 mm were found mainly in the ascending colon and mainly with granular-homogenous (G-H) morphology (40.9% and 46.2%, respectively; p < 0.05). Adenoma was the main histological type in patients with tumors of all diameters. However, the cancerization rate of LSTs was 31% in patients with tumor diameter ≥ 20 mm, while there was no invasive cancer in patients with tumor diameter < 20 mm. In the low-grade dysphasia (adenoma) group, most of the lesions were located in the ascending colon and most had the morphology LST-G-H (35.8% and 39.2%, respectively; p < 0.05). In the cancerization group, most of the lesions were located in the rectum, with the morphology LST-G-M (51.6% and 67.2%, respectively; p < 0.05), and the diameter was larger than that of the adenoma group (33.84 ± 17.99 mm vs 21.68 ± 8.99 mm).Conclusion: The rectum was the most common site for an LST with a diameter ≥ 20 mm and cancerization, of which the morphology was mainly LST-G-M (endoscopic submucosal dissection is the preferred treatment for this type of LST). LST malignancy was found to be correlated with lesion diameter, location, and morphological appearance.Keywords: colorectal laterally spreading tumors, colonic mucosa, colonoscopy, pathological features, malignant tumor