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Endoscopic submucosal dissection for localized amyloidosis of the sigmoid colonSupported by: This work was supported in part by The National Cancer Center Research and Development Fund (29-A-13 and 2020-A-12). 29-A-13 and 2020-A-12
Amyloidosis is a rare disease caused by the extracellular deposition of amyloid, which results from the self-assembly of various precursor proteins with a highly ordered and abnormal cross-β sheet structure  .
Gastrointestinal amyloidosis sometimes leads to ulcer, gastrointestinal bleeding, and intestinal obstruction  . Endoscopic mucosal resection (EMR) has been reported as a treatment for localized amyloidosis of the colon which was causing bloody stool .
An 82-year-old man underwent colonoscopy for follow-up after colorectal polypectomy, and a submucosal tumor (SMT)-like lesion was detected in the sigmoid colon. The lesion was yellowish-white and appeared to be slightly hard ([Fig. 1 a]). It was covered by nonneoplastic epithelium with slight fold stretching. Magnified chromoendoscopy revealed an elongated type I pit, compatible with SMT, and its surface structure appeared to be stretched by the submucosal lesion ([Fig. 1 b, c]). Narrow band imaging (NBI) with magnification revealed a heterogeneous vessel pattern with uneven caliber and a slightly irregular surface pattern ([Fig. 1 d]). On endoscopic ultrasound (EUS), the lesion was hypoechoic with thickening in the third layer, and the border of the lesion was indistinct and partially mosaic-like ([Fig. 1 e]). Biopsy specimens revealed colonic amyloid deposit. A systematic search including upper gastrointestinal endoscopy and small-bowel capsule endoscopy was performed, but no other lesion was detected.
If the amyloid lesion were to increase in size, the patient would be at risk of bowel obstruction and bleeding, so we performed an endoscopic submucosal dissection (ESD) for this SMT ([Video 1]). Histopathological examination showed deposition of eosinophilic unstructured tissue from the mucosa to the submucosa, and orange staining with Congo red staining and amyloid deposition was observed ([Fig. 2 a, b]). Follow-up colonoscopy revealed a scar after ESD but no recurrence was detected.
Video 1 Endoscopic submucosal dissection for localized amyloidosis of the sigmoid colon.
In conclusion, curative resection may be performed for localized amyloidosis of the colon, and endoscopic treatment could be one option for localized amyloidosis.
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