Maimonides Medical Center Brooklyn, NY, United States
Neha Sharma, MBBS1, Kaveh Zivari, MD1, Avleen Kaur, MD1, Meredith E. Pittman, MD1, Negar Niknam, MD2 1Maimonides Medical Center, Brooklyn, NY; 2Queens Hospital Center, Flushing, NY
Introduction: ORISE-gel is a submucosal synthetic lifting agent used during Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD). It can mimic mucin and amyloid in biopsy specimens and can produce a foreign-body reaction. Here we present a case of ORISE-gel TM injection presenting as a colonic polyp due to granulomatous reaction in the submucosa.
Case Description/Methods: A 60-year-old female underwent a screening colonoscopy to reveal a 2 cm slightly elevated (Paris Class 0-lla) laterally spreading sessile serrated polyp along a fold noted in the proximal ascending colon. The base of the polyp was injected with ORISE-gel TM and it was resected piece-meal. On repeat colonoscopy 4 months later to assess the site of piecemeal resection, the former polypectomy site appeared raised and suspicious for a sub-epithelial lesion. The site was again resected and the histopathology report reported it to be colonic mucosa with sub-epithelial amorphous foreign material (ORISE TM), negative for mucin and amyloid stains.
Discussion: ORISE-gel TM is a synthetic solution used as a lifting agent during EMR/ESD. It provides a cushion to facilitate complete resection of the sessile or flat GI lesions, avoid perforation and excessive bleeding. The use of ORISE TM has increased since it was first approved by the US Food and Drug Administration in 2018. During the pathological exams, ORISE TM requires special stains for differentiation from mucin-producing tumors and amyloid. Over time, ORISE TM can produce a foreign-body reaction at the injection site, which can present as a sub-epithelial lesion, as seen in our case.
Figure: (Top row) first colonoscopy, (Middle row) a second look colonoscopy 4 months later, (Bottom row) Pathology.
Neha Sharma indicated no relevant financial relationships.
Kaveh Zivari indicated no relevant financial relationships.
Avleen Kaur indicated no relevant financial relationships.
Meredith Pittman indicated no relevant financial relationships.
Negar Niknam indicated no relevant financial relationships.
Neha Sharma, MBBS1, Kaveh Zivari, MD1, Avleen Kaur, MD1, Meredith E. Pittman, MD1, Negar Niknam, MD2. P0189 - ORISE-Gel Masquerading as a Colonic Polyp, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.