[Management of Colorectal Subepithelial Lesions: Differential Diagnosis and Follow-up]

The use of colonoscopy as a screening tool for colorectal cancer has increased, leading to the increasing detection of colorectal subepithelial lesions (SELs). These lesions are typically asymptomatic at diagnosis, appearing as small, protruding growths covered by normal mucosa. Colorectal SELs represent a diverse spectrum of lesions, and their differentiation based solely on their endoscopic appearance, endoscopic ultrasound, or radiology imaging remains challenging. Although many lesions are benign, certain types, including neuroendocrine tumors, gastrointestinal stromal tumors, and lymphomas, have malignant potential and warrant thorough evaluation and management. Current research, treatment, and follow-up strategies for these lesions are limited, often relying on the guidelines developed for upper gastrointestinal SELs. Unlike upper gastrointestinal SELs, colonoscopy is essential for the follow-up of colorectal SELs. However, it is time-consuming and costly, and obtaining tissue biopsies through endoscopic ultrasound can be technically challenging. This review aims to provide clinicians with foundational insights into managing colorectal SELs, and facilitating optimal patient care through a comprehensive analysis of the existing literature.