The ulcer appeared benign; its edge was not full and its base did not appear deep or click here nodular. The patient elected to have a slightly delayed endoscopic resection, rather than an immediate surgery. He was treated with a short course (2 months) of oral steroids. The ulcer resolved following escalation of medical therapy, and the circumscribed superficial

elevated lesion was treated with endoscopic resection. The pathology indicated LGD. The presence of an ulcer within a lesion, however, may indicate carcinomatous degeneration. Figure options Download full-size image Download high-quality image (226 K) Download as PowerPoint slide Fig. 12. The absence of the border of the lesion needs to be characterized. This ill-defined nodular, friable, irregular

surface was seen in the rectum during surveillance examination. Even following the application of chromoendoscopy, the border remained unable to be visualized. Such a lesion is not amenable to endoscopic resection, and targeted biopsy should be performed. A tattoo of the area for marking was made, and the patient was referred for surgical evaluation. Figure options Download full-size image Download EPZ015666 clinical trial high-quality image (666 K) Download as PowerPoint slide Fig. 13. Signs of NP-CRN in colitic IBD. The detection of flat and depressed neoplasms in colitic IBD, unlike the detection of polypoid neoplasms, relies primarily on the recognition of subtle changes in the mucosa. The subtle findings require constant awareness by the endoscopist for areas that appear to be slightly different than the background in color, pattern, or level. (A) Nonpolypoid lesions typically have a slightly elevated appearance that can often be recognized by a deformity on the colon wall (arrows). (B) Occasionally there may be spontaneous hemorrhage on the surface. The surface may be friable. (C) Obscure vascular pattern or (D) increased erythema (within circle) may suggest a lesion is present, in that these lesions may disturb the mucosal vascular

network. The surface pattern may show Megestrol Acetate (E) villous features or (F) irregular nodularity (arrow). Figure options Download full-size image Download high-quality image (434 K) Download as PowerPoint slide Fig. 14. Interruption of the innominate grooves can alert the endoscopist to the presence of NP-CRN. Innominate grooves, on histology, are mucosal areas where several crypts open into one central crypt. (A) On endoscopy, they are visible in normal colonic mucosa and nonneoplastic lesions (arrows), whereas they are interrupted in neoplastic lesions. (B) These areas can be better observed following the application of dye, such as indigo carmine, as the dye pools into the grooves and makes them appear as blue lines (arrows). Figure options Download full-size image Download high-quality image (481 K) Download as PowerPoint slide Fig. 15. (A, B) Wall deformity is another sign of the presence of NP-CRN.