Objective Laterally spreading tumors (LSTs) have a carcinogenesis rate of 8.4% to 52.5%, and untreated LSTs can develop into adenocarcinoma within 3 years. The aim of this study was to analyze the clinicopathological features and carcinogenesis risk factors of multiple LSTs. Method A total of 222 LSTs were included in the study, including 30 LST-G-homogenous type (LST-G-H) (13.5%), 64 LST-G-mixed type (LST-G-M) (28.8%), 118 LST-NG-flat elevated type (LST-NG-F) (53.2%) and 10 LST-NG-peseudodepressed (LST-NG-PD) (4.5%). A total of 15 Multiple LSTs, occurred in the right colon (80.0%, 12/15), the pathology was mainly low-grade dysplasia (66.7%, 10/15), with endoscopic submucosal dissection (ESD) as the main treatment (60.0%, 9/15). Patients with a history of colon polyps were more likely to appear multiple LSTs. Multiple LSTs were more common in LST-G-H type, and single LSTs were more common in LST-NG-F type. Multivariate Logistic regression analysis showed that the size of lessions > 20mm and the junior endoscopic physicians (OR 5.074, 95%CI 2.011-12.801, P < 0.05) were independent risk factors for LSTs carcinogenesis, in which the size of lessions ≥40mm(OR 5.468, 95%CI 1.792-16.684, P < 0.05) had a higher risk of carcinogenesis. Conclusions The size of lessions > 20mm and the junior endoscopic physicians were independent risk factors for LSTs carcinogenesis. Patients with a history of colon polyps were more likely to appear multiple LSTs. Multiple LSTs were more common in LST-G-H type, and single LSTs were more common in LST-NG-F type.