A clean resection site?

Two EMR sites. The top in the duodenum and the bottom in the rectum
ARE THE SCARS 'CLEAN'? 

■ Both sites look OK

No they don't!

■ Local recurrence in duodenum

You are half correct!

■ Local recurrence in duodenum

You are half right !

■ Local recurrence in duodenum

Yes!

explanation

The teaching point behind these two images is the simple message that it's impossible to see a local recurrence with just 'white light'. You must assess the scars with NBI or dye sprye or both (I do)! In addition, remember that most local recurrences are to be find at the most 'difficult to see edge'.  Perhaps you can only see a local recurrence in retrovertion?  

In these particular cases both have a local recurrence (see below).

​And a final point, particularly if colorectal histology was HGD, you MUST find that EMR site.  This is because the lesion may actually have been a cancer. 

Remember that when our pathologists don't see invasion beyond the muscularis mucosa, they are not allowed to say cancer. They'll say HGD or 'at least HGD' or perhaps, if they really want to emphasise the point: 'at least HGD and we can't exclude invasive cancer' ...