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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. [ABSTRACT FROM AUTHOR]

AIM: Besides nonalcoholic hepatosteatosis (NAFLD) with intracellular deposition of triglycerides in liver, accumulation of adipose tissue also in pancreas, which is seen usually in septa, attracts growing attention. In this study, we aimed to investigate the ultrasonographic (US) and clinical features of non-alcoholic pancreatic steatosis (NAPS) and compare with NAFLD.. MATERIAL & METHOD: The study group consisted of 345 consecutive patients referred to same radiologist for abdominal US. The demographic, anthropometric and laboratory data from medical records were retrospectively collected. The comparison between NAFLD and NAPS was done by these data including obesity, insulin resistance, cholecystolithiasis, lipid profile, and diabetes mellitus (DM). US grading of liver was evaluated as: Grade 0 with absence of any steatosis, Grade 1 (mild) steatosis indicate increased liver echogenicity with normal periportal and diaphragmatic visualisation. Grade 2 (moderate): diffuse increase in parenchymal echogenicity with blurred diaphragmatic and portal vein borders. Grade 3 (severe) steatosis has diffuse echogenicity with poor or no visualisation of portal vein borders, diaphragm and posterior lobes of liver. Similar grading for pancreatosteatosis is as follows: Grade 0 shows similar echogenicity as renal cortical level. Grade 1: mild fatty pancreas with an echogenicity definitely lower than retroperitoneal fat, Grade 2: moderate level image slightly lower than retroperitoneal fat, Grade 3:equal echogenicity with retroperitoneal fat.. RESULTS: Consecutive 345 patients composed of 220 (64%) females and 125 (36%) males had mean age 51±15 years. US evaluation showed 219 (63.5%) of patients had NAFLD and 227 (65,8%) had NAPS. Patients with NAFLD had normal pancreatic echogenicity in 20%, while no NAFLD was assessed in 23% of NAPS. Diabetic patients (n=84, 24%) had discordance of steatosis in NAFLD and NAPS in 19% of cases. Of 219 NAFLD patients 44 (20%) had elevated ALT and regarded as NASH. In these patients 23% had also normal pancreatic echogenicity. In 55% of both liver and pancreatic steatotosis cases (n=271, 79%) had discordance in grading. NAPS was more related with male gender, older age, cholecystolithiasis, hyperglycemia, insülin resistance. NAFLD was more related with obesity, hepatomegaly, Steatosis of both organs were related with DM, age, Body Fat Percentage (BFP), hyperglycemia, hypertriglyceridemia.CONCLUSION: In this study, pancreatosteatosis was not parallel in all aspects of hepatosteatosis by means of US, clinical, demographic and anthropometric features. Despite to grade 2-3 pancreatosteatosis, 28,7% of the cases had normal liver echogenicity. The difference in grading between steatotic cases in liver and pancreas had discordance as 55%. Thus, wide-range studies with operator independent measurements are needed to compare NAFLD and NAPS discordance to identify if any pathophysiological difference exist. [ABSTRACT FROM AUTHOR]

Aim: To analyze the relationship between the serum lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) levels and clinical and histopathological features of biopsy-confirmed nonalcoholic fatty liver disease (NAFLD) patients., Methods: Fifty-three consecutive, biopsy-proven NAFLD patients (31 males and 22 females, mean age 42.5 ± 9.6 years) and 26 age- and gender-matched, healthy controls (14 males and 12 females, mean age 39 ± 10.7 years) were included. The patients with NAFLD were consecutive patients who had been admitted to the hepatology outpatient clinic within the last year and had been diagnosed with NAFLD as the result of liver biopsy. The healthy controls were individuals who attended the outpatient clinic for routine health control and had no known chronic illnesses. The histological evaluation was conducted according to the NAFLD activity scoring system recommended by The National Institute of Diabetes and Digestive and Kidney Diseases Nonalcoholic Steatohepatitis Clinical Research Network. The serum LOX-1 levels were measured using an ELISA kit (Life Science Inc. USCN. Wuhan, Catalog No. E1859Hu) in both patients and healthy controls. A receiver operating characteristic (ROC) curve analysis was used to identify the optimal cutoff value of LOX-1 and thereby distinguish between patients with nonalcoholic steatohepatitis (NASH) and healthy controls. A P-value < 0.05 was considered statistically significant., Results: NAFLD and healthy control groups were similar in terms of age and sex. NAFLD patients consisted of 8 patients with simple steatosis (15%), 27 with borderline NASH (51%) and 18 with definitive NASH (34%). Metabolic syndrome was found in 62.2% of the patients with NAFLD. The mean serum LOX-1 level in biopsy-proven NAFLD patients was 8.49 ± 6.43 ng/mL compared to 4.08 ± 4.32 ng/mL in healthy controls (P = 0.001). The LOX-1 levels were significantly different between controls, simple steatosis and NASH (borderline+definite) cases (4.08 ± 4.32 ng/mL, 6.1 ± 6.16 ng/mL, 8.92 ± 6.45 ng/mL, respectively, P = 0.004). When the cut-off value for the serum LOX-1 level was set at 5.35 ng/mL, and a ROC curve analysis was performed to distinguish between steatohepatitis patients and controls; the sensitivity and specificity of the serum LOX-1 level were 69.8% and 69.2%, respectively., Conclusion: The serum LOX-1 levels were significantly higher in NAFLD patients than in healthy controls. Additionally, the serum LOX-1 levels could differentiate between steatohepatitis patients and healthy controls.