消失但未被遗忘:扩大 ORISE(粘膜下提升剂)相关诊断陷阱和并发症的范围。

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS ACS Applied Bio Materials Pub Date : 2024-07-17 DOI:10.1136/jcp-2024-209419
Pooja Dhorajiya, Sultan Mahmood, Anne Fabrizio, Vikram Deshpande, Monika Vyas
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引用次数: 0

摘要

目的:由于临床并发症,一种用于内窥镜粘膜切除术的合成提升剂 ORISE 已于 2022 年 11 月从市场上召回。尽管如此,预计在可预见的未来,ORISE 相关并发症的影响仍将持续。我们介绍了一个大型单个机构的治疗性切除术系列,这些患者在最初的内窥镜手术中使用了ORISE,重点介绍了与使用ORISE相关的隐患和并发症:方法:对所有显示与使用 ORISE 相关的提升剂肉芽肿(LAGs)的标本进行鉴定。对 H&E 切片进行审查,以确定 LAG 在肠壁和其他器官中的形态特征和范围。将临床印象和大体检查结果与最终病理诊断进行比较:结果:34 例病例(28 例切除和 6 例重复内镜粘膜切除标本)出现 LAG。镜检结果显示,20.5%的病例无残留病灶,64.7%的病例有残留的前驱病灶,14.7%的病例有恶性病灶。64.2%的病例大体可见肿块病变,但显微镜下未发现恶性肿瘤。ORISE出现在血管间隙(9 例)、淋巴结(2 例)、其他器官如阑尾(1 例)和网膜/腹膜(1 例)。临床印象(肿块/肿瘤)与最终病理结果(无残留恶性肿瘤)不一致的病例占 4/34 (11.8%)。结论:结论:ORISE沉积物可能会模仿残留/播散的肿瘤,并促使手术决策发生意外改变。认识到这一隐患对于防止内镜下切除病灶的随访患者接受不必要的手术切除至关重要。
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Gone but not forgotten: expanding the spectrum of ORISE (submucosal lifting agent) associated diagnostic pitfalls and complications.

Aims: A synthetic lifting agent, ORISE, used for endoscopic mucosal resections, has been recalled from the market since November 2022 due to clinical complications. Despite this, the impact of ORISE-associated complications is expected to persist in the foreseeable future. We present a large single institutional series of therapeutic resections from patients for whom ORISE was used for initial endoscopic procedures, highlighting the pitfalls and complications associated with its use.

Methods: All specimens showing lifting agent granulomata (LAGs) associated with the use of ORISE were identified. The H&E slides were reviewed to define the morphological characteristics and extent of LAG in the intestinal wall and other organs. The clinical impression and gross findings were compared with the final pathological diagnosis.

Results: 34 cases (28 resections and 6 repeat endoscopic mucosal resection specimens) showed LAG. On microscopy, 20.5% showed no residual disease, 64.7% also showed residual precursor lesion and 14.7% also showed malignancy. In 64.2% of cases, a mass lesion was seen grossly but no malignancy was identified microscopically. ORISE was present in vascular spaces (n=9), lymph nodes (n=2), other organs such as appendix (n=1) and omentum/peritoneum (n=1). The major discordance between clinical impression (mass/neoplasm) and final pathology (no residual malignancy) was seen in 4/34 (11.8%) cases. LAGs were seen up to 10 months after the use of ORISE in the prior endoscopic procedure.

Conclusion: ORISE deposits may mimic residual/disseminated neoplasm and prompt inadvertent changes in surgical decisions. Awareness of this pitfall is essential to prevent unwarranted surgical resections in patients undergoing follow-up for endoscopically resected lesions.

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来源期刊
ACS Applied Bio Materials
ACS Applied Bio Materials Chemistry-Chemistry (all)
CiteScore
9.40
自引率
2.10%
发文量
464
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