P2238 - OriseTM Gel, A New Submucosal Lifting Agent: Potential Clinical Complications of Its Use: A Case Series

Tuesday, October 26, 2021

10:30 AM – 4:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

KT

Kanwarpreet Tandon, MD

Digestive Disease Institute, Cleveland Clinic Foundation
Weston, FL, United States

Yasar Colak, MD¹, Badar Hasan, MD¹, Kanwarpreet Tandon, MD¹, Sikandar Khan, MD¹, Vaibhav Wadhwa, MD², Pablo Bejarano, MD³, Tolga Erim, DO¹
¹Digestive Disease Institute, Cleveland Clinic Foundation, Weston, FL; ²Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; ³Cleveland Clinic Foundation, Weston, FL

Introduction: One of the current standard approaches in treating superficial lesions in the gastrointestinal tract is endoscopic mucosal resection (EMR). The procedure involves forming a fluid cushion in the submucosal area with a lifting agent, followed by superficial resection. Orise Gel is one of the commonly used lifting agents for EMR. We present a case series that analyzes the characteristic histopathological findings and clinical implications observed where Orise Gel was used before EMR.

Methods: Seven colon resections and their prior EMR specimens where Orise Gel was used were reviewed. For a literature search, relevant studies were included by searching the Medline and Cochrane databases from January 2018 to December 2020.

Results: Histological examination revealed that after the EMR procedure, the Orise Gel material changed its morphological characteristics over time from a basophilic (bluish) non-inflamed pattern to an eosinophilic (pink) type of pattern eliciting a foreign body reaction. The endoscopic appearance and examination of the excised specimens’ weeks after injection gave the impression of a mass in some cases. The material was also present transmurally and in some cases in the peri-intestinal adipose tissue.

Discussion: It was observed that Orise Gel usage leads to a foreign body-type granulomatous reaction. This potential side effect is likely to cause over-diagnosis of a mass/lesion leading to unnecessary surgical interventions. This case series increases the awareness of the changes caused by Orise Gel in the gastrointestinal tract.

Figure: The reaction in the patient with the longest follow-up (198 days) showing palisading of histiocytes and giant cells in a rosette-like formation (Hematoxylin and Eosin, 200X).

Patien	Age/Gender	Indication/endoscopic appearance and location	Initial histological diagnosis	Procedure and finding	Location of the Orise^TM material	Interval injection to excision Days	Histological appearance of Orise^TM
1	70 y/o F	30mm polypoid lesion central depression (Paris classification IIa+c) Ascending colon	TVA	Partial Right colectomy TVA	Mucosa, submucosa	49	Abundant GCs, small nodules of Orise
2	67 y/o F	30mm sessile granular lateral spreading lesion (Paris classification Is) Cecum	TVA	Right hemicolectomy TVA	Submucosa, muscularis propria	198	Palisading histiocytes around Orise, many GCs, histiocytes, lymphocytes
3	59 y/o M	40mm sessile polyp ((Paris classification IIa) Ascending colon	TVA	Right hemicolectomy TVA	Submucosa, muscularis propria, serosa, adipose tissue	13	Infiltrative pattern, paucicellular reaction, bluish mucoid-like, GCs in subserosa
4	52 y/o M	20mm sessile polyp (Paris classification Is) Sigmoid colon	Invasive carcinoma in a TA	Sigmoid resection No residual carcinoma	Submucosa, muscularis propria	46	Abundant GCs
5*	65 y/o F	40mm carpet-like sessile polyp (Paris classification Is) Cecum	Invasive carcinoma	Right hemicolectomy No residual carcinoma Re-exploration*	Submucosa, muscularis propria, adipose tissue, serosa	24 36*	Abundant GCs, neovascularization, lymphocytes in fat and subserosa
6	72 y/o F	12mm lesion (Paris classification IIc) Descending colon	TA with high-grade dysplasia	Transverse descending partial colectomy No residual lesion	Submucosa	93	GCs, small nodules of Orise, fibroblasts
7	59 y/o F	40mm polyp Ascending colon	TA with high-grade dysplasia	Right hemicolectomy	Submucosa, muscularis propria	140	Abundant GCs, infiltrative pattern.

GC: Giant cell, TA: Tubular adenoma, TVA: Tubulovillous adenoma

Table: Summary of clinical and histological features of patients included in the study.

Disclosures:

Yasar Colak indicated no relevant financial relationships.

Badar Hasan indicated no relevant financial relationships.

Kanwarpreet Tandon indicated no relevant financial relationships.

Sikandar Khan indicated no relevant financial relationships.

Vaibhav Wadhwa indicated no relevant financial relationships.

Pablo Bejarano indicated no relevant financial relationships.

Tolga Erim: Boston Scientific – Consultant, Speaker's Bureau.

Yasar Colak, MD¹, Badar Hasan, MD¹, Kanwarpreet Tandon, MD¹, Sikandar Khan, MD¹, Vaibhav Wadhwa, MD², Pablo Bejarano, MD³, Tolga Erim, DO¹. P2238 - OriseTM Gel, A New Submucosal Lifting Agent: Potential Clinical Complications of Its Use: A Case Series, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.