Non-lifting sign

Non-lifting sign.

Depth of invasion is one of the crucial factors to be considered to make appropriate treatment decisions for colorectal neoplastic lesions. However, the endoscopic assessment of depth of invasion prior to the resection of the tumor remains problematic. Non-lifting sign is one of the endoscopic methods that can be used to predict the depth of invasion. If a lesion cannot be lifted by submucosal injection of saline (positive non-lifting sign), it is likely to be a lesion with deep submucosal invasion (invasive carcinoma) and therefore candidate for radical surgical resection. Desmoplastic reaction tethering the invasive carcinoma down is the basis for the non-lifting sign. Several studies have investigated the non-lifting sign as a tool for differentiation between adenoma and sm1-cancer and cancer with deeper infiltration. The results vary. Thus non-lifting sign should not be interpreted in isolation. Morphologic characteristics of lesions, including their rigidity, increased friability, alterations in growth pattern (depressions, noduls) or scaring shoul also be considered. They are regarded as signs of deep invasion. Lesions that have been bioptised previously cannot be assessed for non-lifting sign, because of submucosal scarring.