P0189 - ORISE-Gel Masquerading as a Colonic Polyp

Neha Sharma, MBBS¹, Kaveh Zivari, MD¹, Avleen Kaur, MD¹, Meredith E. Pittman, MD¹, Negar Niknam, MD^2
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.



Disclosures:


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.