Submucosal lifting agent ORISE gel causes extensive foreign body granuloma post endoscopic resection
- PDF / 797,512 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 21 Downloads / 250 Views
CASE REPORT
Submucosal lifting agent ORISE gel causes extensive foreign body granuloma post endoscopic resection Belinda L. Sun 1 Accepted: 17 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Submucosal injection of lifting solution is often performed to facilitate endoscopic mucosal resection or endoscopic submucosal dissection. ORISETM gel is a synthetic solution recently approved by the US Food and Drug Administration (FDA) in 2018 for use as submucosal lifting solution for endoscopic resection procedures and has gained popularity for its convenient pre-filled syringe. However, here the present two cases show that ORISETM gel induces marked foreign body giant cell granulomatous reaction in the submucosa and muscularis propria following endoscopic resection. Methods and results A 73-year-old female underwent laparoscopic right colectomy after her initial endoscopic polypectomy of a hyperplastic polyp, and a 78-year-old male had partial gastrectomy following endoscopic mucosal resection of an invasive adenocarcinoma. Both patients had submucosal injection of ORISETM gel during endoscopic procedures, and the surgical resection specimens showed ORISETM gel deposition and extensive foreign body giant cell granulomatous reaction in the submucosa and muscularis propria. Conclusion These cases raise the awareness that ORISETM gel stimulates extensive foreign body reaction at the injection site, and the further consequence is still unclear. Keywords ORISETM gel . Submucosal injection . Endoscopic resection . Lifting solution . Foreign body giant cell reaction
Introduction Endoscopic resection has gradually become the primary management for gastrointestinal premalignant lesions and early cancers. Polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD) are currently the major endoscopic resection techniques for the removal of polyps or mucosal dysplastic lesions in the gastrointestinal tract, especially in the esophagus, stomach, and colon. EMR is mainly used to remove mucosal lesions larger than 1 cm, while ESD is performed to remove lesions larger than 2 cm or likely having high-grade dysplasia or cancer invading the superficial submucosa [1]. Submucosal injection of lifting solution is often performed to elevate the lesion while separating it from the muscularis propria to facilitate
* Belinda L. Sun [email protected] 1
Department of Pathology, Banner-University Medical Center, University of Arizona, 1605 N Campbell Ave, Tucson, AZ 85721, USA
endoscopic resection and reduce the risk of thermal injury, perforation, and bleeding. Submucosal injection has been reported to significantly improve the successful rate of en bloc tissue resection [2]. Submucosal injection is often used for EMR and required as a necessary step in ESD. Different types of submucosal lifting solution have been used including normal saline, glucose solution, glycerol, sodium hyaluronate (SH), gelatin colloids, hydroxyethyl starch, hydroxypropyl methylcellulo
Data Loading...
