Polypoid Tissue Research Articles

Polypoid heterotopic gastric mucosa: in terminal ileum causing extensive lower gastrointestinal bleeding without Meckel’s diverticulum: a case report

BackgroundHeterotopic gastric mucosa (HGM) can be located in various parts of the gastrointestinal tract. As a rare anomaly in the small intestine, it can become complicated by intussusception, obstruction, gastrointestinal bleeding, and even peritonitis, leading to death.Case presentationThis case report focuses on a 12-year-old Middle Eastern boy who presented with hematochezia and abdominal pain for a couple of days. A tagged Red blood cell (RBC) scan and Technetium scan revealed gastrointestinal bleeding at the lower abdomen, highly suggestive of the diagnosis of Meckel’s diverticulum. Subsequently, exploratory laparotomy revealed contiguous and scattered mucosal lesions with multiple polyps of various sizes in the terminal ileum. Meckel’s diverticulum was absent, and the patient was treated with resection and primary anastomosis. The resected tissue revealed extensive ectopic gastric mucosa and polypoid tissues. The patient recovered uneventfully and was discharged four days after the surgery. The symptoms did not recur within six months after his surgery.ConclusionOur case demonstrated that despite the rarity of multiple polypoid gastric heterotopias in the terminal ileum, it should be considered as one of the differential diagnoses of gastrointestinal tract bleeding.

Living Foreign Body in the Larynx: A Rare Case Report

Foreign body aspiration (FBA) is a common incidence in young children. While living FB like maggots have been reported very frequently, Leeches are rarely reported as FBA at any age. In this case we report a 55-year-old female from rural area presented with hoarseness, dyspnoea and cough since one month, upon Indirect laryngoscopy a blackish aneurysmal like FB in the larynx was seen. A neck computed tomography (CT) demonstrated a polypoidal soft tissue like shadow with changing positions in subsequent axial cuts. Finally, direct laryngoscopy was performed under local anaesthesia in operation theatre and a 9 cm leech was found in the larynx overlying sub glottis and glottis area which was removed immediately with the Luc’s forceps. Keywords: Living foreign body, Larynx, Foreign body aspiration.

Evaluation of whether there is residual polyp tissue after hysteroscopic morcellation at Cam and Sakura City Hospital: a retrospective cohort study

BackgroundIn polypectomy with mechanical hysteroscopic morcellators, the tissue removal procedure continues until no polyp tissue remains. The decision that the polypoid tissues were removed completely is made based on visual evaluation. In a situation where the polyp tissue was visually completely removed and no doubt that the polyp has been completely removed, short spindle-like tissue fragments on the polyp floor continue in most patients. There are no studies in the literature on whether visual evaluation provides adequate information at the cellular level in many patients in whom polypoid tissues have been determined to be completely removed. The aim of the present study was to analyze the pathological results of the curettage procedure, which was applied following the completion of polyp removal with operative hysteroscopy, and to evaluate whether there was residual polyp tissue in the short spindle-like tissue fragments that the mechanical hysteroscopic morcellator could not remove. The secondary aims of this study were to compare conventional loop resection hysteroscopy with hysteroscopic morcellation for the removal of endometrial polyps in terms of hemoglobin/hematocrit changes, polypectomy time and the amount of medium deficit.MethodsA total of 70 patients with a single pedunculate polypoid image of 1.5-2 cm, which was primarily visualized by office hysteroscopy, were included in the study. Patients who had undergone hysteroscopic polypectomy were divided into two groups according to the surgical device used: the morcellator group (n = 35, Group M) and the resectoscope group (n = 35, Group R). The histopathological results of hysteroscopic specimens and curettage materials of patients who had undergone curettage at the end of operative hysteroscopy were evaluated. In addition, the postoperative 24th hour Hb/HCT decrease amounts in percentage, the polypectomy time which was measured from the start of morcellation, and deficit differences were compared between groups.ResultsIn total, 7 patients in the morcellator group had residual polyp tissue detected in the full curettage material. The blood loss was lower in the morcellator group than in the resectoscope group (M, R; (-0.07 ± 0.08), (-0,11 ± 0.06), (p < 0.05), respectively). The deficit value of the morcellator group were higher (M, R; (500 ml), (300 ml), (p < 0.05), respectively). The polypectomy time was shorter in the morcellator group (M, R; mean (2.30 min), (4.6 min), (p < 0.05)).ConclusionsEven if the lesion is completely visibly removed during hysteroscopic morcellation, extra caution should be taken regarding the possibility of residual tissue. There is a need for new studies investigating the presence of residual polyp tissue.

Olfaction and Quality of Life in Patients with Eosinophilic CRS Undergoing Endoscopic Sinus Surgery.

Introduction Chronic rhinosinusitis (CRS) is a common inflammatory disease. This high prevalence leads to high direct and indirect public health costs, which include medical visits, laboratory tests and imaging, pharmacotherapy, hospitalizations, and surgical treatment. Furthermore, CRS has a substantial impact on patient quality of life, affecting productivity and being a common cause of absence from work CRS-associated olfactory dysfunction is highly prevalent, the actual effectiveness of surgical intervention remains inconsistent. Although there are studies evaluating the postoperative course of patients with eosinophilic Chronic rhinosinusitis (eCRS) treated with high-volume budesonide irrigation, there is little objective information regarding the impact of this intervention on olfactory status and quality of life. Objective To conduct a pre- and postoperative analysis of olfaction and quality of life in patients with eCRS treated with surgical intervention followed by high-volume budesonide nasal irrigation. Methods Prospective, descriptive, uncontrolled study of patients with eCRS. All patients underwent pre- and postoperative nasal endoscopy, SNOT-22 questionnaire, and the University of Pennsylvania Smell Identification Text (UPSIT), always by the same previously trained examiner. The SNOT-22 questionnaire and the UPSIT were readministered to all patients at 3 months, 6 months, and 1 year postoperatively, and scores compared with those obtained preoperatively. Results Twenty patients were included in the study, 13 males and 7 females, between the ages of 23 and 65; 8 patients had comorbid asthma. Quantitative evaluation using the UPSIT test showed a significant improvement in olfaction 3 months after surgery, which remained 6 months and 1 year after surgery (p = 0.0063). There was no significant association between eosinophil concentrations in polypoid tissue and postoperative SNOT-22 and UPSIT results. Patients with tissue eosinophils >50 had a lower preoperative UPSIT score. As early as 3 months postoperatively, a significant improvement in quality of life was already noticeable, as represented by a decrease in SNOT-22 values, which persisted through the 1-year postoperative follow-up evaluation (p = 0.0005). Quantitative evaluation using the UPSIT test showed a significant improvement in olfaction 3 months after surgery, which remained 6 months and 1 year after surgery (p = 0.0063). Conclusion Surgery effectively controlled eCRS in patients who adhered to high-volume budesonide nasal irrigation postoperatively. There were significant improvements in quality of life and olfaction, which persisted at least up to one year postoperatively.

Association of Comorbid Asthma and the Efficacy of Bioabsorbable Steroid-eluting Sinus Stents Implanted After Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis with Nasal Polyps

ObjectiveTo identify factors affecting the efficacy of steroid-eluting sinus stents implanted after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).MethodsWe performed a post-hoc analysis of a randomized self-controlled clinical trial on post-operative implantation of bioabsorbable steroid-eluting stents in patients with CRSwNP. Univariate logistic regression analysis was conducted to identify which of the following factors affect the response to post-operative stent implantation: sex, serum eosinophil levels, history of prior surgery, endoscopic scores, and comorbid conditions (asthma and allergic rhinitis). The primary outcome was the rate of post-operative intervention on day 30, and the secondary outcome was the rate of polypoid tissue formation (grades 2–3) on days 14, 30, and 90.ResultsA total of 151 patients with CRSwNP were included in the post-hoc analysis. Asthma was identified as the only risk factor for a poor response to steroid-eluting sinus stents on post-operative day 30, with an odds ratio of 23.71 (95% CI, 2.81, 200.16; P=0.004) for the need for post-operative intervention and 19 (95% CI, 2.20, 164.16; P=0.003) for moderate-to-severe polypoid tissue formation. In addition, the asthmatic group showed higher rates of post-operative intervention and polypoid tissue formation than the non-asthmatic group on post-operative day 30. Blood eosinophil levels were not identified as a risk factor for poor outcomes after stent implantation.ConclusionComorbid asthma, but not blood eosinophil level, impairs the efficacy of steroid-eluting sinus stents in the short term after ESS in patients with CRSwNP.

Schistosomiasis enteropathy diagnosed by real-time endocytoscopy.

Fourth-generation endocytoscopy (EC) integrates a variable-focus lens and provides up to 520× continuous zoom-focus magnification. A single endoscope enables white-light imaging, narrow-band imaging, and cellular-level observation. The so-called virtual histology or optical biopsy has shown promising diagnostic ability in GI malignancies or premalignant lesions. Here, we report unexpected findings in the diagnosis of a rare benign disease. A 43-year-old man without a significant medical history underwent a colonoscopy because of abdominal distension. The colonoscopy showed patchy areas of multifocal white miliary spots in the hyperemic mucosa of the descending colon, with no features of polypoid tissue (A). Endocytoscopic ultramagnified images were obtained after staining with 1% methylene blue and 0.05% crystal violet. The microsurface structure of the gland was obviously destroyed, and a large number of seedlike oval structures were notable under endocytoscopy (CF-H290ECI endocytoscope; Olympus, Tokyo, Japan) (B). The on-site pathologist confirmed these structures to be schistosome eggs. Histologic examination of the targeted biopsy specimen also revealed numerous eggs of schistosome organisms (C, H&E, orig. mag. ×200). We hope that this first reported endocytoscopic observation of schistosomiasis enteropathy may enrich the understanding and application of this novel technique, and we believe that maximum diagnostic yield can be achieved under the guidance of an on-site pathologist, although a trained endoscopist can make the diagnosis in most cases.

Large acrochordon of labium majora: an unusual location

Background: Acrochordon is a soft, round or oval, pedunculated papilloma that can be tan or brown in color. Although acrochordons most commonly appear in the neck, axilla, and groin, they can also appear in unusual sites, such as penis, vulva, and perineum. Most of the lesions are small pedunculated papules or nodules approximately 2–6 mm, but rarely, particularly on the lower section of the trunk, large pedunculated acrochordons can be found. Here we present a large acrochordon on the labium majora.&#x0D; Case Description: A 25 years old woman came to an outpatient clinic because there was a mass on her right labium majora ever since she gave birth three years prior. The size of the mass started off relatively small but has grown significantly over time. From dermatological examination in external genitalia region, there was a solitary, pedunculated, skin-colored mass measuring 10 × 3 cm, attached to right labium majora. There was no redness, ulceration, bleeding or discharge. Cautery excision with local anesthetic was performed to removed the mass. The histopathological examination of the specimen revealed polypoidal tissue lined by epidermal layer, there are proliferation and dilation of capillaries containing erythrocytes in the dermis layer, mild infiltration of lymphocytes and histiocytes. No evidence of malignancy.&#x0D; Conclusion: We report an unusual location of acrochordon presenting with large size. Due to its atypical presentation, it may be confused with a malignancy, necessitating a pathological test. Total excision of the mass is recommended.

A131 ENDOSCOPIC SUBMUCOSAL DISSECTION OF COLORECTAL ADENOMAS AND EARLY ADENOCARCINOMAS: OUTCOMES FROM BRITISH COLUMBIA

Abstract Background Endoscopic resection is the standard of care for the management of colorectal polyps. Larger and more complex polyps require endoscopic mucosal resection (EMR). While complications have been low, EMR is often piecemeal, resulting in indeterminant margins and often a higher recurrence rate. Endoscopic submucosal dissection (ESD) is an advanced endoscopic resection technique with a higher rate of en bloc resection. While more data exist for the resection of gastric lesions with ESD, ESD is becoming more widely used in western countries for the resection of colorectal lesions. Purpose The purpose of this study is to report on the outcomes and rates of complications for colorectal ESD completed in a tertiary centre in British Columbia. Method All colorectal ESD was completed by a senior therapeutic endoscopist who has previously received training in Japan. Retrospective data were collected on all colorectal ESD procedures done in St. Paul’s Hospital from July 11th, 2016, when the procedure first became available, to Aug 30th, 2022. Inclusion criteria were all adults who have undergone ESD for resection of a colorectal lesion. Exclusion criteria were patients younger than 18. Data collected included demographic variables, polyp characteristics, procedural outcomes, and complications. Result(s) A total of 39 ESD procedures were completed. The mean size of the resected lesion was 30.4 mm (range: 5 – 60 mm). Technical success, defined as successful resection of all polypoid tissue, was achieved in 35/39 procedures (89.7%). En-bloc resection was achieved in 27/35 (77.1%) of the completed ESD. The rate of R0 resection was 22/35 (62.9%). Curative resection, defined as technically successful ESD with R0 margin and no lymphovascular invasion, was achieved in 23/39 (59.0%) of the cases and the majority of the patients with non-curative resection that underwent endoscopic surveillance had no recurrence on follow-up. In our cohort, 3/39 (7.7%) patients had adenocarcinoma. None of the ESD resulted in any intra-procedural or delayed perforation. 3/39 (7.7%) patients had clinically significant post-endoscopic resection bleeding. Out of 24 patients that completed follow-up, 4 (16.7%) had recurrence at the resection site that was managed endoscopically. 4/39 (10.3%) of patients required surgery post-ESD. Conclusion(s) In our cohort, ESD is an effective endoscopic resection modality for the management of colorectal adenomas and early adenocarcinoma with a high rate of technical success and low rates of complications. Although the rate of curative resection was low, most were the result of R1 or Rx resection and a majority of the follow-ups in this subgroup demonstrated no further recurrence. The rate of en bloc resection is high, especially given the average size of adenomas in this cohort. Although ESD requires high technical proficiency, its favorable outcomes and low complication rates make ESD highly feasible for the resection of colorectal lesions. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

A135 ENDOSCOPIC SUBMUCOSAL DISSECTION OF GASTRIC ADENOMAS AND EARLY CARCINOMAS

Abstract Background Management of gastric adenoma and early gastric cancer requires endoscopic resection. This can often be achieved with endoscopic mucosal resection (EMR), which has been shown to be effective with a good safety profile. One disadvantage of EMR is that it is often completed piecemeal, leading to indeterminant margins and higher rates of recurrences that require additional intervention. Endoscopic submucosal dissection (ESD) is a more advanced endoscopic resection technique that has been shown to be more effective than EMR at en-bloc resection. ESD requires high technical proficiency but it is becoming more widely available in western countries. Purpose The purpose of this study is to report on the outcomes and rates of complications of gastric ESD completed in a tertiary centre in British Columbia. Method All gastric ESD was completed by a senior therapeutic endoscopist who has previously received training in Japan. Retrospective data were collected on all gastric ESD procedures done in St. Paul’s Hospital from May 7th, 2015, when the procedure first became available, to Aug 30th, 2022. Inclusion criteria were all adults who have undergone ESD for resection of a gastric lesion. Exclusion criteria were patients younger than 18. Data collected included demographic variables, polyp characteristics, procedural outcomes, and complications. Result(s) A total of 49 ESD procedures were completed. The mean size of the resected lesions was 25.3 mm (range: 5 – 100 mm). Technical success, defined as successful resection of all polypoid tissue, was achieved in 48/49 procedures (98.0%). En bloc resection was achieved in 42/48 (87.5%) completed ESD. The rate of R0 resection was also 42/48 (87.5%). Curative resection, defined as technically successful ESD with an R0 margin and no lymphovascular invasion, was achieved in 41/49 (83.7%) of the cases. In our cohort, 8 patients had adenocarcinoma, 5 of which had a curative resection with no evidence of recurrence. None of the ESD resulted in any intra-procedural or delayed perforation. 5/49 (10.2%) patients had clinically significant post-endoscopic resection bleeding. Out of 37 patients that completed follow-up, 3 (8.1%) had recurrence, and all of them were managed endoscopically. 4/49 (8.2%) of patients required surgery post-ESD. Conclusion(s) In our cohort, ESD is an effective endoscopic resection modality for gastric lesions with a high rate of technical success and curative resection. Despite a deeper plane of resection versus other endoscopic resection modalities, its complication rate remains low. Although ESD requires high technical proficiency, its favorable outcomes along with low rates of complication make ESD highly feasible for the resection of gastric lesions. Further research will be needed to study the implementation and outcomes of ESD in a western setting. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

A97 LARGE NON-PEDUNCULATED COLONIC POLYP (LNPCP) OUTCOMES REFERRED FOR ENDOSCOPIC RESECTION IN BRITISH COLUMBIA: A QUALITY ASSURANCE INITIATIVE

Abstract Background Endoscopic resection techniques have become the primary treatment strategy for the vast majority of large (≥ 20mm) non-pedunculated colonic polyps (LNPCPs). Despite this, surgery is still commonly performed with evidence suggesting an increasing trend over time. There is limited Canadian data confirming the effectiveness and safety of an endoscopic management strategy for LNPCPs. Purpose To investigate clinical outcomes of patients referred for endoscopic management of a LNPCP. Method Retrospective single-centre analysis of patients referred to a single endoscopist for the management of LNPCPs within a tertiary referral practice. LNPCPs were further subdivided into non-complicated (NC-LNPCP) or complicated (C-LNPCP) defined as those involving the ileocecal valve, appendiceal orifice, circumferential or previously attempted. Performance outcomes were evaluated by the frequencies of technical success (removal of all polypoid tissue during index procedure) and need for colorectal surgery. Safety was evaluated by the frequencies of clinically significant intraprocedural bleeding (CSIPB), clinically significant post-endoscopic resection bleeding (CSPEB), intra-procedural perforation and delayed perforation. Recurrence (either endoscopic or histologic) was evaluated at first surveillance colonoscopy (SC1). Continuous variables were summarized using median (IQR). Categorical variables were summarized as frequencies (%). To test for association between categorical variables, the Pearson χ2 or the Fisher exact test were used, where appropriate. For continuous variables, the Mann-Whitney U test was used. A probability (p) value of &amp;lt;0.05 was considered statistically significant. Result(s) Between January 2021 to March 2022, 263 LNPCP were referred for endoscopic resection and 41 LNPCP were excluded (23 pedunculated, 14 optical evaluation suggestive of deeply invasive cancer, 4 other). 222 LNPCP (188 NC-LNPCP, 34 C-LNPCP) underwent endoscopic resection. Median size was 25mm (IQR 20-30mm) with the majority undergoing cold snare resection (115, 51.8%). Polyposis (Adenomatous or serrated) was present in 23 (12.6%) cases respectively. Technical success was 97.3%. Cancer was present in 5 (2%). Clinically significant bleeding (CSPEB) occurred in 2.7%, DMI IV in 1.8% and there were no delayed perforations. Recurrence occurred in 4 (3.5%) at SC1 and 11 (5%) required surgery due to technical failure, submucosal invasion on pathology and clinically significant bleeding. Image Conclusion(s) Endoscopic resection as the primary treatment strategy for LNPCPs offers a safe and effective alternative to surgery in British Columbia. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Impact of Chronic Rhinosinusitis with Nasal Polyposis on IL-12 and IL-8.

The pathophysiology of Chronic Rhinosinusitis is coordinated by distinct inflammatory reactions in different individuals. Inflammatory environments with a predominance of Th2 lymphocytes tend also to be rich in eosinophils. These environments are common during the formation of nasal polyps associated with aspirin intolerance, which is also marked by an increase in inflammatory mediators, especially IL-4, IL-5, and IL-13. Despite the significance of these inflammatory mediators, the relevance of IL-12 subunits' presence within eosinophilic nasal polyps, however, has been less studied. The current study aims to evaluate the presence of IL-12 subunits, IL-12p40 and IL-12p70, in eosinophilic nasal polyps and their correlations with IL-8 presence. We compared the concentrations of IL-8, IL12p40, and IL12p70 among samples of eosinophilic nasal polypoid tissue, eosinophilic nasal polypoid tissue associated with aspirin intolerance, and healthy nasal mucosa, using an indirect immunoassay (ELISA) kit. When compared to healthy nasal mucosa, there was a lower concentration of IL-8 in Chronic Rhinosinusitis with Nasal Polyp (CRSwNP) tissue. Aspirin Intolerant polypoid tissue also presented a lower concentration of IL-12 subunits compared to healthy nasal mucosa. There was no significant correlation between IL-8 and IL-12 in the eosinophilic polypoid conditions. In CRSwNP, there is a reduction in IL-8 and IL-12 subunits compared to control, with a lack of correlation between IL-12 and IL-8. The lack of correlation can be justified by a type two inflammatory storm environment.

Low-temperature plasma radiofrequency ablation tuboplasty and myringotomy: A preliminary report

ObjectiveTo evaluate the efficacy of Low-temperature plasma radiofrequency ablation (RF) tuboplasty and myringotomy for treating chronic otitis media with effusion (COME) with chronic obstructive eustachian tube dysfunction (COETD) involving hypertrophic tissue of the ET orifice. Methods and materialsThis was a prospective study of 43 ears with COME and COETD who underwent RF tuboplasty. Outcomes included the ability to perform a Valsalva maneuver, tympanometry results, and TM status. Success was defined by an improvement in tympanogram type and Valsalva maneuver. Follow-up ranged from 4 weeks to 12 months. ResultsA total of 43 ears (43 patients) were included in the study. Mucosal hypertrophy of the ET orifice was seen in 35 (81.4 %) patients, while polypoid tissue was observed in 8 (18.6 %) patients. All patients completed the 12-month follow-up, the success rate was 95.3 % (41/43) at postoperative 3 months, 39/43 (90.4 %) at postoperative 6 months, and 37/43 (86.0 %) at postoperative 12 months. No procedure-related serious adverse events were reported for any patient, and there were no cases of patulous ET. Stenosis/scar of anterior-post wall in the ET orifice occurred in two patients at 6 months postoperatively and in one patient at 12 months postoperatively, which the Valsalva maneuver was positive. Thus, no further treatment was applied for the ET orifice in 3 patients. The risk of stenosis of the ET orifice was 3/47 (6.4 %). ConclusionsRF eustachian tuboplasty may be an effective treatment for patients with COME, COETD and hypertrophic mucosa in the ET orifice, particularly as an adjunct to balloon tuboplasty.

Urothelial Papilloma of Urethra: Mimickers

Urethral neoplasms are relatively rare, considering the diversity of pathological diseases in the urethral region. From the perspective of a urologist or a pathologist, benign urethral lesions may mimic cancer. However, due to the rarity of urethral neoplasms, it can be challenging to finalise the definitive diagnosis. We presented the case of a 53-year-old gentleman, a chronic smoker with a history of painless haematuria for three weeks associated with incomplete voiding and urinary frequency. Cystoscopy revealed fluffy, polypoid tissues over the prostatic urethra. Clinically, urothelial carcinoma cannot be excluded. Interestingly, the histopathological assessment revealed a case of urothelial papilloma. An illustration of the diagnostic approach based on solitary polypoid lesions and papillary neoplasms from the urethra was elaborated. The salient features of each disease spectrum were also highlighted. A pathological approach in conjunction with clinical and radiological findings may help correctly recognise urethral pathology.

Nasal cytology as a reliable non-invasive procedure to phenotype patients with type 2 chronic rhinosinusitis with nasal polyps

BackgroundThe identification of type-2 inflammation in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) acquires a crucial role in the endotypization needed for selecting patients for biological drugs targeting type-2 inflammation: to date, the parameters used include systemic and histological biomarkers. The aim of this study was to investigate whether nasal cytology could identify type-2 inflammation in patients with CRSwNP. MethodologyThirty-three consecutive patients with CRSwNP underwent nasal cytology sampling at the level of the lower nasal turbinate, and of the polypoid tissue, and surgical polyp tissue sample was collected. The cellularity of the 3 collected samples were compared. ResultsMean nasal polyp tissue, nasal polyps cytology and inferior turbinate cytology eosinophils counts were 43.7 ± 39.6 cells/HPF, 32.8 ± 44.7 cells/HPF and 27.6 ± 58.0 cells/HPF respectively with inferior turbinate cytology eosinophils significantly lower than nasal polyp tissue count (p = 0.007). Both mean nasal polyps cytology eosinophils and mean inferior turbinate cytology eosinophils were significantly higher in patients with type-2 CRSwNP (52.5 ± 67.0 cells/HPF vs 12.2 ± 17.3 cells/HPF, p = 0.012, and 32.0 ± 62.1 cells/HPF vs 2.9 ± 2.9 cells/HPF, p = 0.020 respectively). ConclusionsNasal cytology is suitable tool for assessing local biomarkers of type-2 inflammation in CRSwNP.

S1139 Endoscopic Resection Technique Outcomes for Non-Lifting Colorectal Lesions: A Systematic Review

Introduction: Endoscopic mucosal resection (EMR) is dependent on submucosal injectate expansion to allow for effective and safe tissue capture. Non-lifting polypoid tissue can render colorectal neoplasia recalcitrant to EMR. A number of alternative resection modalities and auxiliary techniques targeting non-lifting polypoid tissue have been described. We therefore sought to perform a systematic comparative analysis of existing techniques for non-lifting colorectal neoplasia. Methods: Two authors (BZ, HJK) independently searched MEDLINE and EMBASE (Inception to April 2022) for citations evaluating endoscopic resection technique outcomes for non-lifting colorectal neoplasia. Eligible outcomes included technical success (removal of all visible polypoid tissue), R0 resection, intra-procedural perforation (IPP), clinically significant post-endoscopic resection bleeding (CSPEB), delayed perforation and recurrence. Categorical variables were expressed as frequency (%), with ranges estimated for the outcomes of interest, stratified by their respective techniques. Results: 2395 citations were identified in our search strategy, of which 18 citations provided endoscopic resection technique outcomes for non-lifting colorectal neoplasia (7 endoscopic full-thickness resection (EFTR), 3 endoscopic submucosal dissection (ESD), 3 hybrid resection techniques (2 hybrid EFTR and 1 dissection-enabled scaffold-assisted resection), 2 avulsion techniques, 2 cap-assisted EMR (C-EMR), and 1 ablative technique). Technical success ranged from 79–100% (EFTR: 80-100%, ESD: 79-91%, hybrid technique: 98-100%, avulsion: 100%, C-EMR: 97%, ablation: 96%). R0 for applicable modalities ranged from 54-100% (EFTR: 57-100%, ESD: 54-63%). IPP ranged from 0-9% (EFTR: 0-4%, ESD: 0-9%, hybrid technique: 0-2%, avulsion: 0-3%, C-EMR: 0-9%, ablation: 0%). CSPEB ranged from 0-29% (EFTR: 0-29%, ESD: 0%, hybrid technique: 0-4%, avulsion: 5-6%, C-EMR: 9%, ablation: 4%). Delayed perforation was between 0 -14% (EFTR: 0-14%, ESD: 0-9%, hybrid technique: 0%, avulsion: 0%, C-EMR: 0%, ablation: 0%). Recurrence ranged from 0-43% (EFTR: 0-43%, ESD: 0-4%, hybrid technique: 0-17%, avulsion: 15-17%, C-EMR: 19%, ablation: 26%). Conclusion: Endoscopic resection techniques are effective for non-lifting colorectal lesions. Given the frequency of technical success comparative analyses between existing techniques focusing on the frequency of low-risk T1 colorectal cancer histopathology post-resection and adverse outcomes are needed. (Table) Table 1. - Outcomes and complications of different auxiliary techniques for non-lifting colorectal neoplasia Modaility Number of Studies Number of Lesions Technical Success R0 Intra-procedure Perforation CSPEB 1 Delayed Perforation Recurrence EFTR 2 7 106 80-100% 57-100% 0-4% 0-29% 0-14% 0-43% ESD 3 3 46 79-91% 54-63% 0-9% 0% 0-9% 0-4% Hybrid technique 4 3 84 98-100% N/A 0-2% 0-4% 0% 0-17% Avulsion 2 121 100% N/A 0-3% 5-6% 0% 15-17% Cap-assisted EMR 5 2 82 97% N/A 0-9% 9% 0% 19% Ablation 1 26 96% N/A 0% 4% 0% 26% 1clinically significant post-endoscopic resection bleeding.2Endoscopic full-thickness resection.3Endoscopic submucosal dissection.4Includes hybrid EFTR and Dissection enabled scaffold-assisted resection.5Includes cap-assisted EMR alone and cap-assisted EMR ± cold avulsion ± ablation.

S2002 Colonic Schwannoma: A Cause for Nerves?

Introduction: Schwannomas arise from schwann cells, and though they are the commonest of all peripheral nerve tumors, it is exceedingly rare for them to be detected in the lower gastrointestinal (GI) tract. Here, we present the case of a submucosal colonic schwannoma detected incidentally as part of a routine colonoscopy for colorectal cancer (CRC) screening and discuss the clinical significance of such tumors. Case Description/Methods: A 59-year-old male patient with intermittent constipation presented for colonoscopy for CRC screening. A previous colonoscopy 7 years prior had been unremarkable. Family history was notable for CRC in several second-degree relatives. The patient’s past medical history was significant for non-alcoholic fatty liver disease, well-controlled human immunodeficiency virus infection and prediabetes. Physical examination was unremarkable. At colonoscopy, an 8 mm submucosal lesion was found in the cecum. This was sessile and firm, and did not demonstrate a pillow sign characteristic of lipoma. The lesion was resected using a saline injection-lift technique and hot snare. At histology, the lesion was described as tan-pink polypoid tissue, with negative margins (Figure). Immunohistochemically, the tumor cells were diffusely and strongly positive for S100 and negative for CD117, DOG1, SMA and desmin. This was consistent with a diagnosis of schwannoma. Discussion: When GI schwannomas arise, they are most commonly found in the upper GI tract, with 60-70% of GI cases found in the stomach and only 3% in the colon. There are no clear risk factors for their development other than advanced age. As in our patient’s case, colorectal schwannomas are typically detected incidentally on screening colonoscopies. They can be asymptomatic, or present with rectal bleeding (22.9%), abdominal pain (15.6%) or constipation (7.3%). The mass effect of large schwannomas can lead to colonic obstruction necessitating surgical resection of the tumor, but smaller lesions can typically be resected endoscopically. Schwannomas present as submucosal lesions and are almost always benign, with only atypical versions harboring any malignant potential. Numerous studies have demonstrated that recurrence after complete resection is rare, even after extended follow-up. There is no established guidance regarding follow-up intervals for patients with colorectal schwannomas, owing to their rarity. Based on the lack of malignant potential and the low risk of recurrence, we recommended a repeat colonoscopy in 5 years for our patient.Figure 1.: Cecal schwannoma in macroscopic (left) and microscopic (right) views.

The Use of 0° and 70° Endoscopes in Maxillary Antrostomy.

Performing an effective maxillary antrostomy is critical to improving chronic maxillary sinusitis symptomatology. Incomplete dissection of the uncinate process and failure to incorporate the natural drainage pathway may lead to recirculation and need for revision surgery. The purpose of this study is to determine if 70° endoscopes provide added value in determining incomplete dissection or residual disease. Prospective study of 35 sinuses from 18 patients undergoing FESS for Chronic Rhinosinusitis (CRS) between 11/1/2020 and 4/30/2021. Two fellowship trained Rhinologists initially performed maxillary antrostomies exclusively using a 0° endoscope, then transitioned to a 70° endoscope. Surgeons completed a survey to assess completion of the antrostomy prior to use of 70° endoscope, sino-nasal anatomy, and difficulty of the operation. Intraoperative photographs before and after using a 70° endoscope were evaluated by a third party. Pre-operative CT scans were used to evaluate the sphenoid keel-caudal septum-nasolacrimal duct (SK-CS-NL) angle. Of 35 sinuses from 18 patients all 35 sinuses had CRS with 48.5% having nasal polyposis and 42.9% having active infection. There was residual inflammatory tissue in the anterior maxillary sinus, including polypoid tissue and uncinate process prior to using the 70° endoscope in 82.9% of sinuses. The natural drainage pathway was not incorporated into the dissection in 28.6% of sinuses before converting to 70° endoscope. Incomplete dissection with 0° endoscope was not associated with nasal polyposis (P = .086) or uncinate position (0.741). Narrow SK-CS-NL angles were associated with incomplete dissection of the anterior maxillary sinus with 0° endoscope (16.0° ± 3.0° vs 20.6° ± 3.2°; P = .013). Use of 70° endoscope in maxillary antrostomy may be beneficial in identifying and resecting disease within the anterior maxillary sinus that may otherwise be difficult to find using a 0° endoscope. This is especially true in patients with narrow nasolacrimal duct positioning.

ORAL METASTASIS OF COLONIC ADENOCARCINOMA: A CASE REPORT

A 49-year-old female patient presented with a lobulated reddish swelling on the posterior lower gingiva, causing mobility of the lower second molar and facial asymmetry. The patient's medical history included advanced-staged colonic adenocarcinoma diagnosed 3 months earlier. Panoramic radiography showed a well-defined cortical radiolucent defect measuring 3 cm in the posterior mandible. An incisional biopsy was performed, and macroscopic examination revealed a polypoid soft tissue of fibrous consistency and a whitish homogenous cut surface. Microscopically, glandular tubular structures composed of simple columnar epithelial cells were observed, which were positive for CK20 and negative for CK7, confirming the diagnosis of metastatic colonic adenocarcinoma to the oral cavity. The patient underwent chemotherapy and radiotherapy, but she died after 5 months. Intestinal adenocarcinomas may metastasize to the oral cavity as a gingival swelling in middle-aged adults with a previous malignancy and is diagnosed through the correlation of history, clinical, and immunohistochemical findings.

Sinonasal Malignant Melanoma Variant: A Case Report

Sinonasal malignant melanoma (SMM) is a rare malignant tumour among head and neck cancers predominantly found in adults 60 years and above. The commonly reported symptoms for sinonasal tumour lesions are nasal obstruction and recurrent, painless epistaxis as the symptoms are non-specific and can delay the diagnosis. Moreover, melanoma has a poor prognosis regardless of its location. We report an 86-year-old female patient presenting with recurrent, painless epistaxis from the nasal cavity. Anterior rhinoscopic examination revealed a bluish-black, bleeding mass completely obstructing the left nasal nare. Contrast-enhanced computed tomography of the nasal cavity and sinus region showed a polypoidal soft tissue attenuation with heterogeneous enhancement completely filling the left nasal cavity. The patient underwent endoscopic excision. Histopathology of the specimen showed a small, round and blue cell tumour which immunohistochemistry found to be positive for S100 and HMB 45. After surgical resection, the patient received chemotherapy and radiotherapy. Sinonasal malignant melanoma is a rare, aggressive tumour that has a very poor prognosis. Contrast-enhanced computed tomography of the nasal cavity and paranasal sinuses is the imaging modality of choice which reveals the enhancing mass. There is no optimal management strategy for SMM. Surgical resection is the first-line treatment but is limited due to the complex anatomy of the sinonasal region.

TAS2R38 Bitter Taste Receptor Expression in Chronic Rhinosinusitis with Nasal Polyps: New Data on Polypoid Tissue.

Studies have shown differences in TAS2R38 receptor expression in patients with chronic rhinosinusitis (CRS) compared to healthy controls. Known agonists of TAS2R38 stimulate epithelial cells, leading to robust intracellular nitric oxide (NO) production, which damages bacterial membranes, enzymes, and DNA, but also increases ciliary beat frequency. In this study we examined, using qRT-PCR, the expression of TAS2R38 receptor in nasal polyps (NP) of patients with CRS (N = 107) and in inferior turbinate mucosa (ITM) of patients with CRS and controls (N = 39), and confronted it with clinical features and the severity of the disease. The expression was shown in 43 (50.00%) samples of ITM in the study group (N = 107), in 28 (71.79%) in the control group (N = 39) (p = 0.037), and in 43 (46.24%) of NP. There were no differences in levels of the expression in all analyzed tissues. Patients who rated their symptoms at 0–3 showed higher TAS2R38 expression in ITM in comparison to the patients with 8–10 points on the VAS scale (p = 0.020). A noticeable, however not significant, correlation between the TAS2R38 expression in ITM and the Lund–Mackay CT score was shown (p = 0.068; R = −0.28). Patients with coexisting asthma had significantly higher receptor expression in the NP (p = 0.012). Our study is the first to confirm the presence of the TAS2R38 receptor in NP. Expression of the TAS2R38 receptor is reduced in the sinonasal mucosa in patients with more advanced CRS with NP.