The non-lifting sign is a finding on

endoscopic An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are insert ...

examination that provides information on the suitability of large flat or sessile colorectal polyps for polypectomy by

endoscopic mucosal resection Endoscopic mucosal resection is a technique used to remove cancerous or other abnormal lesions found in the digestive tract. It is one method of performing a mucosectomy. For the esophagous Endoscopic mucosal resection has been advocated for ...

(EMR). When fluid is injected under a polyp in preparation for endoscopic mucosal resection, some polyps do not "lift", indicating that the polyp is not separating from the submucosa. This makes polypectomy more technically difficult, and increases the risk of intestinal perforation if polypectomy is then attempted. It is also thought to be indicative of an early colorectal cancer that has invaded the submucosa significantly (sm3 – invasion down to the lower one-third of the submucosa), which would make surgical removal of the tumour preferable to allow complete removal of the cancer. Consequently, the non-lifting sign is generally considered to be a

contraindication In medicine, a contraindication is a condition that serves as a reason not to take a certain medical treatment due to the harm that it would cause the patient. Contraindication is the opposite of indication, which is a reason to use a certain tre ...

to performing endoscopic mucosal resection. __TOC__

History

The non-lifting sign was first described in 1994 by Yoshiharu Uno and Akihiro Munakata of the Hirosaki University School of Medicine, Japan. In 1999 the same team showed that the presence of a non-lifting sign correlated with the depth of invasion of the submucosa by early colorectal cancers that were being considered for endoscopic resection. The tumours which did lift when fluid was injected were found to be less invasive than those that did not (sm1 or sm2 - invasion confined to the upper two-thirds of the submucosa, with at least 1mm of uninvolved submucosa underneath). It is thought that the non-lifting sign is due to fibrosis around the tumour causing tethering of the tumour to the

muscularis mucosae The lamina muscularis mucosae (or muscularis mucosae) is a thin layer (lamina) of muscle of the gastrointestinal tract, located outside the lamina propria, and separating it from the submucosa. It is present in a continuous fashion from the es ...

. Subsequent research suggested that the non-lifting sign is less accurate in determining depth of tumour invasion than the assessment of tumours by the endoscopist, but still suggests that the presence of the sign makes endoscopic resection technically difficult. However, more recently it has been found that fibrosis may be caused when a tumour is biopsied before endoscopic mucosal resection is attempted, which leads to a false positive non-lifting sign and therefore reduces the apparent accuracy of the sign. The authors, therefore, recommended avoidance of biopsy of the lesions if EMR is to be attempted, and if biopsies have been taken the time before EMR is attempted should be minimised.

References

{{reflist Gastroenterology Endoscopy Surgical procedures and techniques Medical signs