This ASG video tip is brought to you by an educational grant from Braintree, a part of Cibela Pharmaceuticals, makers of SUTAB. Can you determine what type of lesion this is? This is a 62-year-old man undergoing screening colonoscopy. He's asymptomatic. He has this polyploid lesion in the proximal sigmoid colon seen first in white light and then examined in narrowband imaging. Congratulations if you answered granulation tissue in a diverticulum. This is something we reported seeing about one in every 125 to 150 routine colonoscopies. We reported this a number of years ago. These are typically small lesions. They're located right in the diverticulum. Most of them are in the sigmoid. Only occasionally do you see them over a centimeter in size, usually fairly smooth. The clues are the absence of any discernible pit pattern on the surface. They often appear ulcerated or have some patchy exudate on the surface, sometimes in a regular vascular pattern. If you want to confirm the diagnosis, you don't need to remove it. You can just take a cold biopsy and it'll come back as ulcerated tissue granulation tissue. Fairly common finding, here's another example, you can again see the absence of any discernible pits, the evidence of ulceration, the white exudate that's on the surface of the lesion.

62-year-old man

screening colonoscopy

polyploid lesion

proximal sigmoid colon

granulation tissue