P1129 - Novel Use of Full Thickness Resection Device to Ensure Complete Resection of Colonic MALT Lymphoma Post-Endoscopic Mucosal Resection

Anuj Shah, MBBS¹, Amrita Sethi, MD², Andrew Joelson, MD³, Ava Anklesaria, MBBS^4
1Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India; ²New York-Presbyterian/Columbia University Irving Medical Center, New York, NY; ³Cooperman Barnabas Medical Center, Glen Ridge, NJ; ⁴Columbia University Irving Medical Center, New York, NY

Introduction: Mucosa-associated lymphoid tissue (MALT) lymphoma, a subtype of non-Hodgkin lymphoma, primarily affects the upper gastrointestinal tract, with colonic involvement being extremely rare.

Case Description/Methods: A 72-year-old woman with Systemic Lupus Erythematosis on methotrexate presented with anemia. Endoscopic workup revealed H. Pylori gastritis on endoscopy. Colonoscopy revealed a 1 cm flat polyp in the descending colon, which was removed by endoscopic mucosal resection and found to be a MALT lymphoma on pathology. PET scan showed no metastasis. To ensure complete removal, she subsequently underwent a repeat colonoscopy with full-thickness resection(FTR) of the EMR scar site using the FTRD (OVESCO endoscopy). Pathology confirmed R0 resection. On follow-up CT scans, she remains in remission.

Discussion: Colonic MALT lymphoma can present asymptomatically or with bleeding, pain, perforation, or intussusception. Endoscopic appearance of these lesions is varied. Given the limited available data, there is no standardized treatment protocol. Options for treatment include surgical resection, chemotherapy, radiotherapy, endoscopic resection, or a combination of the above. Some reports suggest first-line treatment strategy is extremely important as it is harder to achieve remission after the failure of the first line of treatment. We, therefore, sought to ensure the completeness of the resection of the EMR with full-thickness resection of the EMR scar site. We report a novel use of the FTR device to ensure complete resection of a colonic MALT lymphoma without subjecting the patient to invasive surgery.


Disclosures:


Anuj Shah, MBBS¹, Amrita Sethi, MD², Andrew Joelson, MD³, Ava Anklesaria, MBBS⁴. P1129 - Novel Use of Full Thickness Resection Device to Ensure Complete Resection of Colonic MALT Lymphoma Post-Endoscopic Mucosal Resection, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.