The photograph shows a transverse colonic polyp that was found in a 55-year-old man who was under surveillance because of a 15-year history of ulcerative colitis. Analysis of biopsy samples has indicated that the polyp is a tubular adenoma harbouring low-grade dysplasia.
HOW WOULD YOU MANAGE THIS LESION?
a) This is probably a sporadic polyp that can be removed endoscopically.
b) Offer endoscopic resection only if analysis of a full set of random mucosa samples, taken throughout the colon, does not reveal any flat invisible dysplasia.
c) Endoscopically, this is a dysplasia-associated lesion or mass (DALM), but an endoscopic attempt at resection would nevertheless be appropriate.
d) The concept of a DALM is outdated and an attempt at endoscopic resection should be undertaken.
e) This patient should be offered a pan-proctocolectomy with ileo-anal pouch anastomosis.