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• W4200217886 abstract "Olivas et al1Olivas A.D. Setia N. Weber C.R. et al.Histologic changes caused by injection of a novel submucosal lifting agent for endoscopic resection in GI lesions.Gastrointest Endosc. 2021; 93: 470-476Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar reports on the histopathologic changes associated with the use of ORISE gel (Boston Scientific, Marlborough, Mass, USA). In this single-center retrospective review of 58 EMR and endoscopic submucosal dissection (ESD) cases, ORISE gel was identified in 51 (88%) of the resected specimens as an amorphous pale blue-gray material. Moreover, ORISE gel was negative for both histochemical stains for periodic acid–Schiff (PAS) and mucicarmine on selected specimens. Last, 5 interval surgical specimens of EMR/ESD cases with use of ORISE gel revealed extensive deposition of dense submucosal and sometimes transmural eosinophilic material with associated multinucleated giant cells. Putting aside some of the limitations mentioned in this study, including the relatively small sample size and the unaccounted amount of ORISE gel injected in each case, certain points deserve further comment. Our group and others have shown that the amorphous pale acellular ORISE gel can mimic mucin on histologic examination.2Ashwini E. Liu X. Draganov P.V. et al.ORISE gel: a submucosal lifting agent mimics mucin in endoscopic resection specimen.ACG Case Rep J. 2020; 23e00403Google Scholar,3Cypher L. Sun S. Forster E. et al.Submucosal lifting agent ORISE gel remnants histopathologically mimic mucin and malignancy: a case series.Am J Clin Pathol. 2019; 152: 573Crossref Google Scholar Although Olivas et al1Olivas A.D. Setia N. Weber C.R. et al.Histologic changes caused by injection of a novel submucosal lifting agent for endoscopic resection in GI lesions.Gastrointest Endosc. 2021; 93: 470-476Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar indicate that ORISE gel was identified as a procedural artifact in all of their cases without requiring special stains, we strongly recommend that stains for PAS and mucicarmine be considered whenever these histologic findings are encountered so as to avoid a misdiagnosis of mucinous adenocarcinoma. Certain histologic features, including submucosal hemorrhage, which we have witnessed in our practice and have been previously reported, were not identified in this study.4Pezhouh M.K. Burgart L.J. Chiu K. et al.Characterization of novel injectable lifting agents used in colonic polyp removal: an emerging amyloid mimic.Am J Surg Pathol. 2020; 44: 793-798Crossref PubMed Scopus (6) Google Scholar Such variations in ORISE gel–related histologic changes may be due to various factors, but they highlight the need for larger prospective studies controlling for endoscopic resection techniques (EMR vs ESD), site in the GI tract, and tissue specimen handling and processing. Until then, the use of ORISE gel or any other submucosal lifting agent should be clearly documented in the endoscopic procedure to provide clinical context and assist during histologic interpretation. Dr Yang is a consultant for Boston Scientific, Lumendi, and Steris Endoscopy. Dr. Draganov is a consultant for Boston Scientific, Olympus America, Cook Medical, Microtech, Steris Endoscopy, Merit, Lumendi, and Fujifilm. The other author disclosed no financial relationships." @default.
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• W4200217886 date "2022-01-01" @default.
• W4200217886 modified "2023-09-24" @default.
• W4200217886 title "Histologic changes with a novel submucosal lifting gel for endoscopic resection: more than just a lift" @default.
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• W4200217886 doi "https://doi.org/10.1016/j.gie.2021.07.018" @default.
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