Features of endoscopic procedure site reaction associated with a recently approved submucosal lifting agent

Castrodad-Rodríguez, Carlos A.; Panarelli, Nicole C.; Gersten, Adam; Liu, Qiang; Feely, Michael; Jabbour, Tony El

doi:10.1038/s41379-020-0509-0

Cited by 12 publications

(16 citation statements)

References 21 publications

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“…Besides, photo-crosslinked chitosan hydrogel could form SFCs in-situ, however, it should be irradiated with UV light for 5 min to form an elevated mucosa, which was not feasible in vivo experiments 24 . Additionally, the high viscosity of normal gel like Cook Medical's submucosal lifting gel and ORISE™ Gel Submucosal Lifting Agent also limits its application in ESD 25,26 .…”

Section: Discussionmentioning

confidence: 99%

Crosslinkable poloxamer in-situ gel as a submucosal cushion for endoscopic submucosal dissection

Gao

Huang

Chen

et al. 2020

Preprint

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Background: Hypertonic saline solution is used for endoscopic submucosal dissection (ESD) as a submucosal fluid cushion (SFC). However, the application of SFC is limited by challenges including a short effect duration as well as increased risk of perforation and bleeding.Methods: An in-situ gel crosslinked acrylate/thiol Poloxamer 407 (PA-PSH) can be used as a novel SFC for ESD to avoid perforation, and the feasibility and safety of the PA-PSH for ESD was evaluated in vitro and in vivo .Results: PA-PSH thermal injection led to a longer-lasting elevation with clearer margins as compared with glycerol, with a high mucosal elevation induced by thiol-ene reaction in physiological conditions between acrylate Poloxamer 407 (PA) and thiol-capped Poloxamer 407 (PSH). Precise ESD along the margins of the elevated mucosa was achieved without obvious adverse effects such as bleeding, perforation and tissue damage.Conclusion: The PA-PSH in-situ gel provides an excellent submucosal injection system, which has great potential to improve the ESD technique.

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Section: Discussionmentioning

confidence: 99%

Crosslinkable poloxamer in-situ gel as a submucosal cushion for endoscopic submucosal dissection

Gao

Huang

Chen

et al. 2020

Preprint

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“…Besides, photo-crosslinked chitosan hydrogel could form SFCs in-situ, however, it is not feasible enough as it should be irradiated with ultraviolet light for at least 5 min to form an SFC 24 . Additionally, the high viscosity of normal gel like Cook Medical's submucosal lifting gel and ORISE™ Gel Submucosal Lifting Agent also limits its application in ESD 25,26 .…”

Section: Discussionmentioning

confidence: 99%

Crosslinkable poloxamer in-situ gel as a submucosal cushion for endoscopic submucosal dissection

Gao

Huang

Chen

et al. 2020

Preprint

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Hypertonic saline solution is used for endoscopic submucosal dissection (ESD) as a submucosal fluid cushion (SFC). However, short duration time and side effects like perforation and bleeding have limited the application of SFC. Here, an in-situ gel crosslinked acrylate/thiol Poloxamer 407 (PA-PSH) was used as an SFC for ESD to avoid perforation, and the feasibility and safety of the PA-PSH for ESD was evaluated in vitro and in vivo. PA-PSH thermal injection led to a longer-lasting elevation with clearer margins as compared with glycerol, with a high mucosal elevation induced by thiol-ene crosslinked acrylate Poloxamer 407 (PA) and thiol-capped Poloxamer 407 (PSH) in physiological conditions. ESD was achieved precisely without obvious adverse effects and tissue damage. The PA-PSH in-situ gel provides an excellent submucosal injection system, which has great potential to improve the ESD technique.

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“…Eleview and ORISE are recently introduced synthetic lifting agents. They are injected into the submucosa during an endoscopic procedure to fully visualize and resect flat or sessile lesions 5,[33][34][35][36] (Figure 4, A and B). They are most commonly seen in the resection of sessile colonic polyps, but can also be used for removal of sessile lesions in the esophagus, stomach, and small bowel ( Table 1).…”

Section: Submucosal Lifting Agentsmentioning

confidence: 99%

“…33,37,38 Histopathologic Examination ORISE and Eleview have a similar histologic appearance. 5,35,36 These agents are best seen in the submucosa, and the morphology changes with time. Immediately after injection, the agent has a similar appearance to acellular mucin on H&E and manifests as extracellular pale, bluegray, amorphous, and variably bubbly to finely granular material ( Figure 4, C and D).…”

Section: Submucosal Lifting Agentsmentioning

confidence: 99%

“…Resection 2 to 3 months after lifting agent injection grossly presents as a white-tan, firm submucosal mass. Histologic sections show prominent amorphous, pink hyaline-like material with a foreign body giant cell reaction and fibrosis, also referred to as lifting agent granuloma 5,35,36,39 (Table 2; Figure 4, E and F). The hyalinized ribbons and globules seen in the older lesions are thought to represent degrading lifting agent or a tissue reaction to the degrading agent.…”

Section: Submucosal Lifting Agentsmentioning

confidence: 99%

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Karamchandani

Hammad

Chetty³

et al. 2021

Archives of Pathology &Amp; Laboratory Medicine

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Context.— With the increasing development and use of iatrogenic agents, pathologists are encountering more novel foreign materials in retrieved gastrointestinal specimens. These colorful and unusual-appearing foreign materials can pose a diagnostic dilemma to those unaware of their morphology, especially if the relevant clinical history is lacking. Objective.— To discuss the histopathologic features, clinical scenarios and significance, and differential diagnosis of relatively recently described, yet quickly expanding, family of iatrogenic agents that can present as foreign materials in gastrointestinal specimens—pharmaceutical fillers (crospovidone and microcrystalline cellulose), submucosal lifting agents (Eleview and ORISE), lanthanum carbonate, hydrophilic polymers, OsmoPrep, yttrium 90 microspheres (SIR-Sphere and TheraSphere), and resins (sodium polystyrene sulfonate, sevelamer, and bile acid sequestrants). Data sources.— We collate the findings of published literature, including recently published research papers and authors' personal experiences from clinical sign-out and consult cases. Conclusions.— Correct identification of these iatrogenic agents is important because the presence of some novel agents can explain the histopathologic findings seen in the background specimen, and specific novel agents can serve as diagnostic clues to prompt the pathologist to consider other important and related diagnoses. Awareness of even biologically inert agents is important for accurate diagnosis and to avoid unnecessary and expensive diagnostic studies.

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Features of endoscopic procedure site reaction associated with a recently approved submucosal lifting agent

Cited by 12 publications

References 21 publications

Crosslinkable poloxamer in-situ gel as a submucosal cushion for endoscopic submucosal dissection

Crosslinkable poloxamer in-situ gel as a submucosal cushion for endoscopic submucosal dissection

Crosslinkable poloxamer in-situ gel as a submucosal cushion for endoscopic submucosal dissection

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