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Don’t judge a book by its cover: except during optical evaluation
  1. Neal Shahidi1,2,3,
  2. W Arnout van Hattem2,
  3. Sergei Vosko2,
  4. Michael J Bourke2,3
  1. 1Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
  3. 3Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Neal Shahidi, Department of Medicine, University of British Columbia, Vancouver V6T 1Z4, Canada; nealshahidi{at}

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A healthy 41-year-old female was referred for the endoscopic management of a large rectal laterally spreading lesion (LSL). On index colonoscopy, performed for the evaluation of rectal bleeding, multiple proximal sessile serrated polyps were identified meeting diagnostic criteria for serrated polyposis syndrome. Family history was notable for a sister with a history of sessile serrated polyps.

Using an Olympus 190 series high-definition colonoscope (Olympus, Tokyo, Japan), the lesion was evaluated under white-light (figure 1A), narrow-band imaging (NBI) (figure 1B) and near-focus (figure …

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  • Contributors Drafting of the article: NS. Critical revision of the article for important intellectual content: WAvH, SV, MJB. Final approval of the article: MJB.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.