Elsevier

Gastrointestinal Endoscopy

Volume 40, Issue 4, July–August 1994, Pages 485-489
Gastrointestinal Endoscopy

The non-lifting sign of invasive colon cancer,☆☆,,★★,

https://doi.org/10.1016/S0016-5107(94)70216-0Get rights and content

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PATIENTS AND METHODS

Two hundred five colorectal lesions, 5 mm or more in size, from 157 patients who underwent treatment at our institution between July 1991 and July 1993 were investigated. The morphologic classification of these lesions was 1 exophytic tumor, 2 ulcerated tumors, 3 annular tumors, 98 semi-pedunculated polyp-type lesions, 91 sessile polyp-type lesions, and 10 depressed (IIc + IIa) lesions.

Colon preparation consisted of lavage with 2 to 3L of an oral polyethylene glycol electrolyte solution. Three

RESULTS

Of the 205 lesions investigated, a positive non-lifting sign was found in 12 (Table 1). These lesions included 1 adenoma, 1 intramucosal carcinoma, 4 invasive carcinomas, and 6 carcinomas that had invaded from the muscularis propria to the serosa. The 6 advanced carcinomas and 4 invasive carcinomas were resected by laparotomy. Two lesions were less than 10 mm in size, 4 were between 10 and 19 mm, and 6 were 20 mm or more. In most cases, after injection of methylene blue detachment of the

DISCUSSION

Most cases of colorectal carcinoma originate as adenoma, develop into intramucosal carcinoma, then progress to invasive carcinoma. Only adenomas and intramucosal carcinomas are completely curable by endoscopic resection alone.5, 6, 7 As an invasive carcinoma may metastasize to a lymph node, a colectomy is usually performed.

It is difficult to assess the extent of a cancerous invasion accurately by means of conventional colonoscopy alone. Determining the depth of a sessile-type carcinoma is

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    In addition, LST-NG lesions often have submucosal fibrosis that can make their removal with simple snare resection or even standard endoscopic mucosal resection (EMR) more technically challenging. The nonlifting sign for sessile polyps was described by Uno et al,36 whereby fluid injected under the polyp fails to lift it. The nonlifting sign may be due to deep submucosal invasion37 in lesions without prior endoscopic manipulation or attempted resection.

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From the First Department of Internal Medicine, Hirosaki University School of Medicine, Hirosaki, Japan.

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This work was supported by a JTE (The Japanese Foundation for Research and Promotion of Endoscopy) Grant.

Reprint requests: Yoshiharu Uno, MD, Internal Medicine, Hirosaki University School of Medicine, 5 Zaifu-cho, Horosaki, 036, Japan.

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GASTROINTESTINAL ENDOSCOPY

37/69/54111

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