Is there anything at all there?

This red patch was noted in the transverse colon. You take samples and after the examination, the patient asks you what will happen next?
WHAT WILL YOU REPLY?

■ It's probably nothing

This is SOMETHING!

■ It will probably need to be resected endoscopically

Its a TA+HGD which had to be removed by ESD

■ It will probably need to be resected surgically

Now, that would be 'overkill' !

explanation

Actually, this lesion turned out to be a TA harbouring HGD !!!   Those crypts in the centre were small and round (Kudo's IIIs crypts) which are found in TA's harbouring HGD.  Your pathologists will know that as the dysplasia progresses towards cancer, the mucosal crypt shrink and eventually disappear altogether with the lesion becomes a cancer. 

It's an example of an exceedingly rare completely flat lesion (IIb type of lesion).  There is not many of these in the colon!  Image a film of faeculent fluid on top! It would render it absolutely invisible!  Rembacken's Resection Rule #2: Wash all the Bubbles and Drain all the Puddles !!! 

Anyway, it lifted poorly. Predictably as both LST-NG's and LST-D's also never lift well.  It had to be removed by ESD (see photograph).