This ASG video tip is brought to you by an educational grant from Braintree, a part of Cibela Pharmaceuticals, makers of SUTAB. How do you recognize the current? That is also very important. So you've done your best, you go in and you want to examine to find out whether there is any recurrence or residual at the site. So find the scar, very important. You may have tattooed it or you know exactly where it is and examine that area with white light as well as electronic chromatoscopy. Use your knowledge of NICE and WASP classification to identify any residual adenoma. And another important thing that we discussed in the previous talk also was how to differentiate between residual adenoma and post clipping artifact. Now even this is a study by Doug Rex where in spite of not seeing any visible adenoma, if you biopsy the scar in about six to 7% or 8% of patients, you may find some microscopic evidence of adenoma. However, more recent studies have shown that if you examine the scar, you do a good job. So this is again, a big lesion that I removed. We discussed about it and you examine the scar, looks very bland, very similar under NBI to the surrounding mucosa, confirms that there is no residual adenoma. Compared to that, you have this scar where you can see the convergence of folds, you can see clear NICE type II pattern, and this is clearly residual adenoma at the site. Whereas if you see these polyploid areas at the site of the scar and you examine them under NBI and the pattern on the surface is very bland, similar to what the surrounding colonic mucosa shows, then that is clearly evidence of post clipping artifact. And these are the ones that you do not even have to biopsy, don't worry about them. You can just see the distribution, they will be spread all across the area of the post EMR scar, wherever your clip was placed. And these are benign and have no clinical implication. Here is a short video of showing the same. You can see the scar, little depressed area with convergence of the folds, you see a little bit of polyploid tissue here. If you didn't know about post clipping artifact, you would worry that this could be residual adenoma. Here we change, turn to NBI and closely examine the surface, very bland appearing, similar color to the surrounding mucosa, exactly the same pattern as the surrounding mucosa on the surface of this confirms that this is post clipping artifact. Thanks for watching!

residual adenoma

post clipping artifact

scar examination

NICE classification

WASP classification