1. Thickened submucosal adipose tissue layer during endoscopic submucosal dissection of inflammatory bowel disease dysplasia.
- Author
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Alkhayyat M, Akki A, Gorgun E, Rieder F, and Bhatt A
- Subjects
- Humans, Inflammatory Bowel Diseases surgery, Inflammatory Bowel Diseases pathology, Female, Male, Colonoscopy methods, Middle Aged, Endoscopic Mucosal Resection methods, Adipose Tissue pathology, Intestinal Mucosa pathology, Intestinal Mucosa surgery
- Abstract
Competing Interests: Disclosure E. Gorgun is a consultant for Olympus, Boston Scientific, and DiLumen. F. Rieder is a consultant or administrative board member for Adiso, Adnovate, Agomab, Allergan, AbbVie, Arena, Astra Zeneca, Boehringer-Ingelheim, Celgene/BMS, Celltrion, CDISC, Celsius, Cowen, Ferring, Galapagos, Galmed, Genentech, Gilead, Gossamer, Granite, Guidepoint, Helmsley, Horizon Therapeutics, Image Analysis Limited, Index Pharma, Landos, Jannsen, Koutif, Mestag, Metacrine, Mopac, Morphic, Organovo, Origo, Palisade, Pfizer, Pliant, Prometheus Biosciences, Receptos, RedX, Roche, Samsung, Sanofi, Surmodics, Surrozen, Takeda, Techlab, Teva, Theravance, Thetis, UCB, Ysios, and 89Bio. A. Bhatt is a consultant for Medtronic, Boston Scientific, and Steris and the recipient of royalties from Medtronic. All other authors disclosed no financial relationships. Commentary Deposition of submucosal fat is a well-known finding in patients with chronic IBD. This phenomenon is called the fat halo sign on CT scan of IBD patients and often indicates a long-standing inflammatory state. Given that most visible polypoid lesions in patients with IBD harbor a higher risk of dysplasia or intramucosal adenocarcinoma, these lesions should be removed via ESD in an en bloc fashion. During ESD, it is essential to dissect within the lower third of the submucosa to ensure the resection of the majority of the submucosal layer in case of submucosal invasion. It is worth mentioning that adipose tissue within the submucosa is highly vascular, and bleeding control is suboptimal during dissection in fat tissue because fat is not electroconductive. As the authors mentioned, it is better to dissect beneath the thickened fat layer in the submucosa, not only to ensure curative resection but also to prevent bleeding. Tara Keihanian, MD, MPH, Assistant Professor, Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA Amy Tyberg, MD, FASGE, FACG, GIE Associate Editor for Focal Points
- Published
- 2024
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