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Colon cancer prevention
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
When a lesion is seen at colonoscopy a decision must be made regarding the feasibility of endoscopic resection. Almost all stalked polyps are amenable to snare resection, but the decision can be more difficult for sessile lesions which may or may not be malignant. Endoscopic ultrasound with a 20-MHz miniprobe passed through the biopsy channel can define the layers of the colonic wall and assess invasion [1]; however, this modality is not widely available and often the endoscopist must rely upon the look and feel of the lesion in assessing endoscopic resectability. Any lesion that is ulcerated, irregular or feels hard and fixed to the underlying muscle layer during palpation with the biopsy forceps is probably not suitable for endoscopic resection. Another useful indicator of invasion is to inject saline submucosally (see below) into normal, adjacent mucosa and observe whether or not the lesion lifts on the saline cushion. Sessile lesions that fail to lift after submucosal saline injection (non-lifting sign) [2] are likely to be malignant and endoscopic resection should not be attempted.
Endoscopy and Management of Colorectal Polyps
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
The injection of fluids into the submucosal layer is the key procedure for a successful EMR. Furthermore, this injection has diagnostic value. A non-lifting sign suggests malignancy with tumour infiltration in the muscular layer (T2). Of course, this has to be distinguished from other reasons for a non-lifting sign, such as scarring after previous resections or inflammation.
Factors associated with non-lifting of colorectal mucosal lesions
Published in Scandinavian Journal of Gastroenterology, 2023
Jiang-Ping Yu, Shao-Peng Yang, Rong-Wei Ruan, Sheng-Sen Chen, Yan-Dong Li, Hai-Bin Lou, Shi Wang
Non-lifting sign is characterized by injection of saline solution into the submucosal layer of the tumor and the lesions is not lifted, first described by Uno in 1994 [1]. Non-lifting sign is frequently used for evaluation of invasion depth. For some time, it has been believed that non-lifting signs was associated with deeper invasion carry the potential risk of lymph node metastasis, so surgical management is reasonable [2,3]. However, some recent studies with small sample size have indicated that the rate of carcinogenesis or invasive carcinoma in non-lifting colorectal lesions is 4–8.5% [4–6] and non-lifting sign does not reliably predict deeper cancerous invasion [7]. Thus, there may be other causes of non-lifting sign such as submucosal fibrosis, and it does not necessarily preclude endoscopic therapy.
Endoscopic full-thickness resection of benign and malignant colon lesions with one-year follow up in a Danish cohort
Published in Scandinavian Journal of Gastroenterology, 2022
Mustafa Bulut, Niels Buch, Svend Knuhtsen, Ismail Gögenur, Lasse Bremholm
All patients referred to undergo EFTR at the two centres (Zealand University Hospital and Odense University Hospital) between December 2016 and December 2017 were included consecutively in this prospective study. We included patients with non-lifting colonic lesions, who were not eligible for standard endoscopic resection with polypectomy, EMR, or ESD. The eligible lesions were estimated to have a diameter below 25 mm and exhibit a non-lifting sign or characteristics of submucosal invasion. In cases with previous attempts of treatment, the non-lifting sign was confirmed by submucosal injection. The lesions were assessed with high-definition white-light and digital chromoendoscopy (narrow band imaging, NBI). Important characteristics of submucosal invasion were morphologically depressed surface (Paris III, IIc and IIa + IIc), fold convergence, and also irregular surface pattern and vessels in NBI. The included lesions were untreated, residual, or recurrent adenomas or early adenocarcinomas. All eligible cases were discussed at a multidisciplinary team (MDT) conference in order to ensure the necessary paraclinical examinations and achieve a consensus on the treatment strategy. Written informed consent was obtained from all patients. Patients under the age of 18, pregnant women, or those incapable of providing written consent were excluded.