Art in Endoscopy: “The Whale”

Sessile serrated lesion after submucosal dye injection.

This is a sessile serrated lesion after submucosal dye injection, just before endoscopic mucosal resection. The prominent adenomatous nodule reveals progression to cytologic dysplasia, which is a late step in the serrated neoplasia pathway to colorectal cancer. Often, an adenomatous nodule in a polyp is mistaken for a small tubular adenoma by the endoscopist, while the surrounding nondysplastic area of sessile serrated lesion is easily overlooked because of its subtle appearance. This might lead to resection of only the adenomatous nodule, leaving in situ the rest of the lesion.

Arne Bleijenberg, Barbara Bastiaansen
Amsterdam, The Netherlands

“Art in endoscopy” is an initiative of four gastroenterologists in training that aims to display examples of the incidentally beautiful images that are sometimes encountered in regular endoscopic practice.