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which discusses ORISE gel–related foreign body giant cell reaction (FBGCR) leading to submucosal findings that may be misinterpreted during surveillance endoscopy. FBGCR is increasingly documented in the literature as lifting agents become more commonly used in endoscopic practice.
We demonstrate a case of lifting agent–related FBGCR leading to an EUS finding of an 8-mm submucosal thickness.
A 56-year-old woman was undergoing colonoscopy after a positive fecal immunochemical test result. She was found to have a 1-mm polyp in the ascending colon and 2 polyps in the rectum (4 mm proximal and 14 mm distal) (Fig. 1). The rectal polyps were removed by the use of EMR with ORISE gel (Boston Scientific, Marlborough, Mass, USA) (Fig. 2). Histologic analysis revealed tubular adenomas with high-grade dysplasia.
Colonoscopy in December 2020 revealed a submucosal nodule in the rectum 50 mm from the anal verge (Fig. 3). EUS demonstrated 8 mm of rectal wall submucosal thickening (Fig. 4). After the patient was lost to follow-up, she underwent repeated colonoscopy in October 2021, which showed postmucosectomy scars in the rectum. Histologic analysis did not demonstrate any residual adenomatous tissue at the scar site; however, the submucosal nodule in the distal part of the rectum was still present.
Figure 3Submucosal lesion at the post-EMR site as seen on surveillance colonoscopy.
Subsequent MRI demonstrated an area in the distal part of the rectum suggestive of lymphadenopathy. After referral to a colorectal surgeon, the patient underwent full-thickness biopsy. A final histologic examination demonstrated FBGCR, negative for dysplasia or malignancy.
This case demonstrates FBGCR due to ORISE visualized endoscopically, histologically, and endosonographically.
Identification of the abnormal US findings detailed here is of important clinical benefit. In patients undergoing endoscopic procedures where ORISE gel is used, endoscopists should recognize the potential of FBGCR leading to submucosal abnormalities on EUS. Awareness of this artifact can help reduce misidentification of pathologic tissue and decrease the need for unnecessary diagnostic interventions.
Disclosure
Both authors disclosed no financial relationships.
References
Olivas 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.
ORISE Gel is a recently introduced, U.S. Food and Drug Administration-approved submucosal lifting agent used in endoscopic resection of GI lesions. Histologically evident gel deposits in resected specimens may pose a potential diagnostic pitfall. To aid in recognition of this procedure-related artifact, we report the largest histologic series of ORISE Gel in endoscopic and surgical resection specimens to date.
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