Lateral spreading tumors are superficial spreading neoplasms now increasingly diagnosed using high definition endoscopy and chromoscopic colonoscopy. There are two types of LST: granular type (LST-G) and non-granular type, (LST-NG). LST-NG type, especially the pseudodepressed type, has a significantly higher frequency of submucosal invasion than LST-G type. LSTs are usually removed, therefore, by endoscopic mucosal resection (EMR) but larger tumors (> 2 cm) may require piecemeal resection in case of LST-G type. Endoscopic submucosal dissection (ESD) allows en-bloc resection irrespective of the size of the lesionand is indicated in LST-NG type or large elevated lesions suspected to be carcinoma. Transanal endoscopic microsurgery (TEM) offers a minimally invasive alternative to radical surgery. Rectal ESD is still under evaluation in France in a SFED/INCa prospective trial.