This ASG video tip is brought to you by an educational grant from Braintree, a part of Cibela Pharmaceuticals, makers of SUTAB. We're in the CECM and clearly this is a patient who has melanosis coli. The prep is not bad, it's actually very good, but this is a patient who has used laxatives of the anthraquinone class on a long-term basis and now has extensive pigmentation of the colon. This, of course, is lipofuscin. It's located in the macrophages of the lamina propria and we're going to see a lesion that does not appear to have taken up this pigment and we're going to get a look at it and we'll switch in just a second to the close focus mode to evaluate the pits and the question is what is this lesion? This is a conventional adenoma actually a tubular adenoma a flat one arising in a background of melanosis coli. Conventional adenomas don't take up the lipofusion pigment in melanosis coli so we have a sort of natural chromo endoscopy where these lesions appear light against the dark background and oftentimes very flat lesions are visible in melanosis coli. You can also see the pit pattern here the very thin blood vessels and tubular white structures the the pits this is the surface pit pattern NICE 2 or KUDO 3L consistent with a conventional adenoma. you

melanosis coli

laxatives

lipofuscin accumulation

tubular adenoma

pit pattern