Potential clinical complications of OriseTM gel use, a new submucosal lifting agent: experience from a tertiary care center and review of the literature

Abstract

Background Endoscopic mucosal resection (EMR) involves forming a fluid cushion in the submucosal area with a lifting agent, followed by superficial resection. OriseTM gel is one of the commonly used lifting agents for EMR. We present a case series and literature review that analyzes the characteristic histopathological findings and clinical implications observed where OriseTM gel was used before EMR.

Methods Colon resection specimens and prior EMR specimens where OriseTM gel was used were reviewed for patients undergoing EMR between January 2018 and December 2020. The literature review included relevant studies from the Medline and Cochrane databases from January 2018 to December 2020.

Results A total of 12 colon polyp EMRs using Orise gel were performed during the study period. Seven patients (58.34%) underwent surgical resection. Histological examination revealed that, after the EMR procedure, the OriseTM gel material changed its morphological characteristics over time from a basophilic (bluish) non-inflamed pattern to an eosinophilic (pink) type 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.

Conclusions It was observed that OriseTM gel use elicits a foreign body-type granulomatous reaction. This potential side effect may lead to overdiagnosis of a mass/lesion and unnecessary surgical interventions. This case series and review of the literature aims to increase awareness of the changes caused by OriseTM gel in the gastrointestinal tract.

Keywords Endoscopic mucosal resection, OriseTM gel, foreign body giant cell reaction, colectomy, colonoscopy

Ann Gastroenterol 2022; 35 (4): 407-413