{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T21:12:47Z","timestamp":1788901967021,"version":"build-2803163510"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Endoscopic submucosal dissection (ESD) for colorectal lesions becomes particularly challenging in the presence of the muscle-retracting sign (MRS), and the risk of perforation is further increased when a diverticulum underlies the lesion. We report a case of ESD for a 25-mm Paris type 0\u2013Is tumor in the sigmoid colon surrounded by multiple diverticula. During ESD, a broad MRS obscured the appropriate submucosal plane. Careful dissection revealed a diverticulum directly beneath the lesion, indicating a focal defect of the muscularis propria. Subsequently, an intraoperative perforation occurred but was immediately detected and successfully closed using endoscopic clips, allowing completion of en bloc resection. Postoperative computed tomography demonstrated minimal free air, and the patient recovered uneventfully with conservative management. This case highlights that even in an extremely high-risk situation involving both an MRS and an underlying diverticulum, careful dissection and prompt endoscopic closure may avoid surgery and achieve curative resection.<\/jats:p>","DOI":"10.1093\/omcr\/omag169","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:27:52Z","timestamp":1787570872000},"source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic submucosal dissection for a colorectal tumor with coexisting muscle-retracting sign and underlying diverticulum: the first reported case"],"prefix":"10.1093","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5767-9921","authenticated-orcid":false,"given":"Taiji","family":"Yoshimoto","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Tachikawa Sogo Hospital , 4-1 Midoricho, Tachikawa, Tokyo 190-8578 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Matsuyama","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Tachikawa Sogo Hospital , 4-1 Midoricho, Tachikawa, Tokyo 190-8578 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayaka","family":"Nakanishi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Tachikawa Sogo Hospital , 4-1 Midoricho, Tachikawa, Tokyo 190-8578 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kei","family":"Nakatani","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Tachikawa Sogo Hospital , 4-1 Midoricho, Tachikawa, Tokyo 190-8578 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosuke","family":"Nagakura","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Tachikawa Sogo Hospital , 4-1 Midoricho, Tachikawa, Tokyo 190-8578 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroo","family":"Ishii","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Tachikawa Sogo Hospital , 4-1 Midoricho, Tachikawa, Tokyo 190-8578 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Takihara","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Uji Tokushukai Hospital , 145 Ishibashi, Makishima-cho, Uji, Kyoto 611-0041 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"2026090817005210900_ref1","doi-asserted-by":"publisher","first-page":"E246","DOI":"10.1055\/s-0034-1391665","article-title":"Clinical significance of the muscle-retracting sign during colorectal endoscopic submucosal 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retrospective multicenter study","volume":"12","author":"Chiba","year":"2024","journal-title":"Endosc Int Open"},{"key":"2026090817005210900_ref5","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1007\/s10151-025-03151-1","article-title":"Dissection of giant bulky colorectal lesions with muscle retracting sign (MRS+): strategic management of gravitational traction during ESD might be the solution","volume":"29","author":"Zormpas","year":"2025","journal-title":"Tech Coloproctol"},{"key":"2026090817005210900_ref6","doi-asserted-by":"publisher","first-page":"E664","DOI":"10.1055\/a-0848-8048","article-title":"Endoscopic submucosal dissection in management of colorectal tumors near or involving a diverticulum: a retrospective case series","volume":"7","author":"Jimenez-Garcia","year":"2019","journal-title":"Endosc Int Open"},{"key":"2026090817005210900_ref7","doi-asserted-by":"publisher","first-page":"3479","DOI":"10.1007\/s00464-020-07795-y","article-title":"Endoscopic submucosal dissection for colorectal neoplasms in proximity or extending to a diverticulum","volume":"35","author":"Muramoto","year":"2021","journal-title":"Surg Endosc"},{"key":"2026090817005210900_ref8","doi-asserted-by":"publisher","first-page":"417","DOI":"10.5946\/ce.2021.245","article-title":"Feasibility and safety of endoscopic submucosal dissection for lesions in proximity to a colonic diverticulum","volume":"55","author":"Ikezawa","year":"2022","journal-title":"Clin Endosc"},{"key":"2026090817005210900_ref9","doi-asserted-by":"publisher","first-page":"E305","DOI":"10.1055\/a-1961-1800","article-title":"Colorectal endoscopic submucosal dissection using the water pressure method for diverticulum-associated lesions: a case series study (with video)","volume":"11","author":"Masunaga","year":"2023","journal-title":"Endosc Int Open"}],"container-title":["Oxford Medical Case 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