Assessment of submucosal distortion and mass effect seen at follow-up after colorectal EMR with ORISE (with video)

      Background and Aims

      ORISE (Boston Scientific, Marlborough, Mass, USA) is a viscous gel used for submucosal injection. We noted anecdotally that ORISE is associated with submucosal distortion of EMR scars at follow-up.


      We blindly reviewed photographs of 30 consecutive EMR scars at follow-up after resections using ORISE and 30 resections using other agents. Distortion was scored on a scale of 0 (no submucosal distortion) to 5 (overt submucosal distortion).


      The median submucosal distortion score at follow-up in ORISE cases was 3 (range, 0-5) versus 0 (range, 0-2) with other fluids (P < .001, Mann-Whitney U test) by 1 reviewer and 3 (range, 0-5) versus 2 (range, 0-5), respectively, by a second reviewer (P = .018). The kappa value for agreement in the submucosal distortion scores between the 2 experts was .148 for all photographs and .214 for the ORISE cases (overall minimal agreement).


      ORISE can cause submucosal distortion in the region of EMR scars when they are viewed at follow-up. Such distortions must not be mistaken for submucosal tumor growth.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kaltenbach T.
        • Anderson J.C.
        • Burke C.A.
        • et al.
        Endoscopic removal of colorectal lesions-recommendations by the US Multi-Society Task Force on Colorectal Cancer.
        Gastrointest Endosc. 2020; 91: 486-519
        • Repici A.
        • Wallace M.
        • Sharma P.
        • et al.
        A novel submucosal injection solution for endoscopic resection of large colorectal lesions: a randomized, double-blind trial.
        Gastrointest Endosc. 2018; 88: 527-535
        • Rex D.K.
        • Broadley H.M.
        • Garcia J.R.
        • et al.
        SIC-8000 versus hetastarch as a submucosal injection fluid for EMR: a randomized controlled trial.
        Gastrointest Endosc. 2019; 90: 807-812
        • Moss A.
        • Bourke M.J.
        • Metz A.J.
        A randomized, double-blind trial of succinylated gelatin submucosal injection for endoscopic resection of large sessile polyps of the colon.
        Am J Gastroenterol. 2010; 105: 2375-2382
        • El Rahyel A.
        • Abdullah N.
        • Love E.
        • et al.
        Recurrence after endoscopic mucosal resection: early and late incidence, treatment outcomes, and outcomes in non-overt (histologic-only) recurrence.
        Gastroenterology. 2021; 160: 949-951
        • Pezhouh 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: 793-798
        • 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.
        Gastrointest Endosc. 2021; 93: 470-476
        • Westbrook L.M.
        • Henn P.A.
        • Cornish T.C.
        Lifting agent granuloma.
        Am J Clin Pathol. 2020; 153: 630-638
        • Cypher 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: S73
        • Cohen J.
        A coefficient of agreement for nominal scales.
        Educat Psychol Measure. 1960; 20: 37-46
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Sreepati G.
        • Vemulapalli K.C.
        • Rex D.K.
        Clip artifact after closure of large colorectal EMR sites: incidence and recognition.
        Gastrointest Endosc. 2015; 82: 344-349
        • Rex D.K.
        Diagnosis and management of clip artifact on endoscopic mucosal resection scars.
        Gastroenterol Hepatol. 2021; 17: 464-468