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Información de la revista
Vol. 41. Núm. 9.
Páginas 572-573 (noviembre 2018)
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Vol. 41. Núm. 9.
Páginas 572-573 (noviembre 2018)
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Target sign: An important diagnostic tool
Target sign: una importante herramienta de diagnóstico
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2319
Richard Azevedo
Autor para correspondencia
richardazevedo13@gmail.com

Corresponding author at: Gastroenterology Department, Amato Lusitano Hospital, Avenida Pedro Álvares Cabral, 6000-085 Castelo Branco, Portugal.
, Ana Caldeira, António Banhudo
Gastroenterology Department, Amato Lusitano Hospital, Castelo Branco, Portugal
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A 69-year-old man was submitted to an en bloc endoscopic mucosal resection (EMR) of a 20-mm non-granular laterally spreading tumor, Paris Classification 0-IIa+c, located in the sigmoid colon (Fig. 1A). Immediately after EMR an imminent colonic perforation was identified: examination of the mucosal defect revealed a mirror target sign (Fig. 1B). The defect was successfully closed with 5 endoscopic clips (Fig. 1C). The specimen was retrieved and the target sign was confirmed on examination of the underside of the lesion (Fig. 1D). The patient was discharged 6h after uneventful clinical surveillance. Histopathological assessment revealed a high-grade dysplasia tubular adenoma without submucosal invasion and clear margins (Fig. 2A), confirming partial muscularis propria (MP) resection (Fig. 2B).

Figure 1.

(A) Endoscopic image of the 20mm non-granular laterally spreading colonic tumor. (B) The mirror target sign identified immediately after EMR of the lesion. (C) Endoscopic closure of the MP defect with 5 clips. (D) Target sign on the resected specimen.

(0.44MB).
Figure 2.

(A) High-grade dysplasia tubular adenoma without submucosal invasion. ×100. Hematoxylin-eosin staining. (B) Specimen showing partial resection of the muscularis propria (*). ×20. Hematoxylin-eosin staining.

(0.24MB).

Colonic perforation may occur in up to 10% of EMR and endoscopic submucosal dissections. The target sign, an easily recognizable endoscopic marker of the MP resection, indicates a potential risk for colonic perforation. The mirror target sign is characterized by the presence of 2 concentric white rings in the mucosal defect: the inner ring, corresponding to the point of MP resection, and the outer ring corresponding to the site of cauterized mucosa.1

Early identification of this sign allows prompt endoscopic closure, avoiding one of the most feared complications – colonic perforation. As so, it constitutes an endoscopic diagnostic tool with important clinical value.

Reference
[1]
M.P. Swan, M.J. Bourke, A. Moss, A. Hopper, A. Metz.
The target sign: an endoscopic marker for the resection of the muscularis propria and potential perforation during colonic endoscopic mucosal resection.
Gastrointest Endosc, 73 (2011), pp. 79-85
Copyright © 2018. Elsevier España, S.L.U.. All rights reserved
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