uh greetings let us learn about the classification of colon polyps and what we will do is we will learn about the classification and then look at the various endoscopic pictures to assign that particular classification this is a pedunculated polyp as you can see here there's a pedicle and this is the polyp and this is a pediculated polyp and this is usually referred to as one p according to the paris classification the paris classification came up with the classification of various mucosal lesions and polyps this is peninculated polyp think about how do you keep uh remembering these different polyps think about a mushroom and mushroom has a stock mushroom has a head and when you try to hit on top of the mushroom with like a hammer and try to squeeze it down and as the stages go you will appreciate the classification of the paris classification of polyps so this is pedunculated polyp and this is semi-pedunculated polyp the stock has become smaller there is still a stock and there is a head this is a semi-patent collated polyp otherwise referred referred to as one as semi-p pedenculated pallet and if you push it further down it becomes a sessile polyp that is 1s so cell polyp is any polyp where the height is more than the width and and the height is at least above the size of a biopsy forceps put on the mucosa so whenever it is about that size it is usually referred to as a cell polyp and when you press it down further it is known as superficial elevated otherwise referred to as 2a lesion where the polyp is elevated above the mucosa but it is less than the height of a biopsy forceps placed on the mucosa when a superficial elevated polyp is larger than 10 millimeters it is known as laterally spreading tumor and if it has granular surface it is known as laterally spreading tumor of the granular type on the other hand if it is smooth without granular surface granular smooth it is known as laterally spreading tumor of the non-granular type so superficially elevated 2a that is bigger than 10 millimeters is known as laterally spreading tumor and when the lesion is flat just a tad bit are almost about the same level as the mucosa it is known as a true flat lesion otherwise known as 2b lesion and when it is depressed it is 2c lesion when it is depressed and one of the edges is a little bit up it is a mixed relation where you call 2c uh slash 2c slash 2a so we've learned about this i want to go over this one more time in one picture here is the pedenculated polyp 1p semi-pedanculated polyp 1sp sessile polyp 1s superficial elevated to a flat 2b depressed 2c mixed 2c slash 2a so this is an image that you need to learn so that when you see polyps you can assign that paris classification among all these lesions depressed lesions and either alone or with a mixed pattern are the ones that we should worry more because they tend to have cancer all these other lesions can be benign or may have cancer if their size is very big but even small depressed lesions you should worry about it because they tend to have advanced pathology and even cancer now let us look at with an endoscope so this is a pediculated polyp 1p and here is the pedicle and this is the head here is the pedicle and this is the head the pre-cancerous area is all in the head and if you cut the stock you will get rid of the polyp with a clear margin so important to cut the polyp here rather than here and if you leave some tissue that will come back so this is a pedenculated pallet 1s or sessile polyp so you can see it is protruding above height is more than the size of a biopsy forceps this is a flat superficial elevated lesion 2a lesion as you can see and it has granules and it's a big one more than 10 millimeters it is a 2a lesion more than 10 millimeters granular surface otherwise known as laterally spreading tumor of the granular type on the other hand here the lesion is smooth and this is slightly elevated that is laterally spreading tumor of the non-granular type i don't have a 2c lesion to show you but here is a 2c lesion with a little bit of 2a this is the mix relation i hope this is useful thank you