2019 Volume 61 Issue 1 Pages 55-61
Muscle-retracting sign (MR sign) is sometimes seen in large protruded-type lesions of the colon during endoscopic submucosal dissection (ESD). Exfoliation must be discontinued when MR sign is observed during ESD. However, it is difficult to predict whether MR sign will be present before the ESD procedure. We experienced three cases in which the ESD procedure had to be discontinued due to MR sign at our hospital. In an attempt to predict the presence of MR sign before ESD, miniature probe endoscopic ultrasonography (mEUS, 20MHz) has been performed at our hospital. Endoscopic ultrasonography (EUS)-MR sign was defined as positive when the muscle layer extends continuously from the base of the lesion to the inside of the lesion on mEUS. As a result, among 8 patients who underwent mEUS, 3 were positive for EUS-MR sign and these three patients were positive for MR sign during ESD as well. Among the five EUS-MR sign-negative patients, all of them showed negative MR sign during ESD. Findings from EUS-MR signs were consistent with the presence or absence of MR sign in all cases. These results may indicate that EUS is one of the procedures that can preoperatively predict the presence of MR sign which has been considered difficult.
