Large caecal polyp

This 75 year old man underwent a CTC because of a change in bowel habit which has confirmed a large caecal polyp. The patient has been referred for a snare polypectomy. 
WHAT WOULD YOU DO NEXT?

■ Abort the procedure and reassure the patient

Absolutely!

■ Take a full set of samples

Uneccessary and they will only show normal mucosa

■ Remove the polyp by snare polypectomy

No need!

■ Remove the polyp by EMR

Foolish!

■ Remove the polyp by ESD

Idiotic!!!

explanation

​The location and the 'pillow sign' tells you that this lesion is a lipoma. We know from Shrisha Hebbar's Podcast that the ICV is a high risk location for any attempt at removing lipomas. He mentions a patient of his who presented with acute small bowel obstruction due to engorgement of an ICV lipoma after the placement of an Olympus ligation. 

Furthermore, you wouldn't of course go ahead with an attempt at resecting a lipoma without due consideration of  indications.  How long has the patient had symptoms? Are they getting better?  Are symptoms likely to arise because of this soft and floppy lesion.  Probably unlikely and statistically speaking, this elderly patient is probably far more likely to have a change in bowel habit due to constipation.  

By the way, please take notice of the odd looking mucosal crypt pattern which is reminiscent of a TVA!  This is the normal crypt pattern at the ICV at the transition to the villous surface in the terminal ileum!