Clinical significance of the muscle-retracting sign during colorectal endoscopic submucosal dissection
submitted 03 October 2014
accepted after revision 31 October 2014
05 May 2015 (eFirst)
Background and study aims: During colorectal endoscopic submucosal dissection (ESD), the feature of a muscle layer being pulled toward a neoplastic tumor is sometimes detected. We call this feature the muscle-retracting sign (MR sign). The aim of this study was to evaluate whether the MR sign is associated with particular types of neoplastic lesions and whether it has any clinical significance for ESD sessions.
Patients and methods: A total of 329 patients underwent ESD for 357 colorectal neoplasms. The frequency of positivity for the MR sign was evaluated in different morphologic and histopathologic types of neoplasm. The success rate of complete resection and the incidence of complications were also evaluated according to whether lesions were positive or negative for the MR sign.
Results: The rates of positivity for the MR sign in the various lesion types were as follows: laterally spreading tumor – granular nodular mixed type (LST-G-M), 9.6 %; laterally spreading tumor – granular homogeneous type (LST-G-H) and laterally spreading tumor – nongranular type (LST-NG), 0 %; sessile type, 41.2 %. The resection rate was 100 % (329 /329) in lesions negative for the MR sign; however, it was 64.3 % (18 /28) in lesions positive for the MR sign, which was significantly lower (P < 0.001).
Conclusions: The MR sign was present only in some protruding lesions, and more importantly, it was associated with a high risk of incomplete tumor removal by ESD. Our data indicate that lesions positive for the MR sign lesions should be dissected with great caution; alternatively, based on the features of the individual case, a switch to surgery should be considered for the benefit of the patient.
- 1 Tanaka S, Oka S, Kaneko I et al. Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc 2007; 66: 100-107
- 2 Saito Y, Uraoka T, Yamaguchi Y et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 2010; 72: 1217-1225
- 3 Toyonaga T, Man-i M, Fujita T et al. Retrospective study of technical aspects and complications of endoscopic submucosal dissection for laterally spreading tumors of the colorectum. Endoscopy 2010; 42: 714-722
- 4 Tanaka S, Oka S, Chayama K. Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection. J Gastroenterol 2008; 43: 641-651
- 5 Tanaka S, Terasaki M, Kanao H et al. Current status and future perspectives of endoscopic submucosal dissection for colorectal tumors. Dig Endosc 2012; 24: 73-79
- 6 Tanaka S, Tamegai Y, Tsuda S et al. Multicenter questionnaire survey on the current situation of colorectal endoscopic submucosal dissection in Japan. Dig Endosc 2010; 22 (Suppl. 01) 2-S8
- 7 Huang Q, Fukami N, Takeuchi T et al. Interobserver and intra-observer consistency in the endoscopic assessment of colonic pit patterns. Gastrointest Endosc 2004; 60: 520-526
- 8 Stergiou N, Haji-Kermani N, Schneider C et al. Staging of colonic neoplasms by colonoscopic miniprobe ultrasonography. Int J Colorectal Dis 2003; 18: 445-449
- 9 Togashi K, Konishi F, Ishizuka T et al. Efficacy of magnifying endoscopy in differential diagnosis of neoplastic and non-neoplastic polyps of large bowel. Dis Colon Rectum 1999; 42: 1602-1608
- 10 Liu HH, Kudo SE, Juch JP. Pit pattern analysis by magnifying chromoendoscopy for the diagnosis of colorectal polyps. J Formos Med Assoc 2003; 102: 178-182
- 11 Fujii T, Matsuda T. Chromoendoscopic and magnifying observation for colorectal submucosal carcinoma [in Japanese]. Gastroenterol Surg 2005; 28: 659-665
- 12 Sano Y, Ikematsu H, Fu K et al. Meshed capillary vessels by use of narrow-band imaging for differential diagnosis of small colorectal polyps. Gastrointest Endosc 2009; 69: 278-283
- 13 Katagiri A, Fu K, Sano Y et al. Narrow band imaging with magnifying colonoscopy as diagnostic tool for predicting histology of early colorectal neoplasia. Aliment Pharmacol Ther 2008; 27: 1269-1274
- 14 Ikematsu H, Matsuda T, Emura F et al. Efficacy of capillary pattern type IIIA/IIIB by magnifying narrow band imaging for estimating depth of invasion of early colorectal neoplasms. BMC Gastroenterol 2010; 10: 33
- 15 Shimura T, Ebi M, Yamada T et al. Magnifying chromoendoscopy and endoscopic ultrasonography measure invasion depth of early stage colorectal cancer with equal accuracy on the basis of a prospective trial. Clin Gastroenterol Hepatol 2014; 12: 662-668
- 16 Tajiri H, Kitano S. Complications associated with endoscopic mucosal resection: definition of bleeding that can be viewed as accidental. Dig Endosc 2004; 16: 134-S136
- 17 Ott DJ, Gelfand DW, Wu WC et al. Colon polyp morphology on double-contrast barium enema: its pathologic predictive value. AJR Am J Roentgenol 1983; 141: 965-970
- 18 Ikehara H, Saito Y, Matsuda T et al. Diagnosis of depth of invasion for early colorectal cancer using magnifying colonoscopy. J Gastroenterol Hepatol 2010; 25: 905-912
- 19 Kobayashi K, Mukae M, Ogawa T et al. Benefits and risks associated with cutoff values of invasion depth of 1,000 μm in patients with colorectal submucosal cancer. Intestine 2012; 16: 130-135 (in Japanese with English abstract)
- 20 Saitoh Y, Obara T, Einami K et al. Efficacy of high-frequency ultrasound probes for the preoperative staging of invasion depth in flat and depressed colorectal tumors. Gastrointest Endosc 1996; 44: 34-39