title: Autolysis: a plausible finding suggestive of long ESD procedure time.
abstract: Autolysis is the enzymatic digestion of cells by the action of its own enzymes, and it mostly occurs in dying or dead cells. It has previously been suggested that prolonged procedure time could lead to autolytic changes from the periphery of the endoscopic submucosal dissection specimens. Recently, the authors have experienced a case of autolysis; due to the presence of ulcer, fibrosis, and frequent bleeding from the cut surface, it took 6 hours to complete the resection. More than halfway through the resection; bluish purple discoloration of the part of the dissected flap where the dissection was initiated was noticed. Histologic examination of this site showed diffuse distortion of epithelial lining and cellular architectures along with loss of cell components, compatible with autolysis. Because autolysis could theoretically pose a potential problem regarding the evaluation of resection margin, endoscopists and pathologists should communicate with each other for a reliable pathologic decision.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Jong Jin
authors.initials: JJ
authors.lastname: Hyun
authors.forename: Hoon Jai
authors.initials: HJ
authors.lastname: Chun
authors.forename: Bora
authors.initials: B
authors.lastname: Keum
authors.forename: Yeon Seok
authors.initials: YS
authors.lastname: Seo
authors.forename: Yong Sik
authors.initials: YS
authors.lastname: Kim
authors.forename: Yoon Tae
authors.initials: YT
authors.lastname: Jeen
authors.forename: Hong Sik
authors.initials: HS
authors.lastname: Lee
authors.forename: Soon Ho
authors.initials: SH
authors.lastname: Um
authors.forename: Chang Duck
authors.initials: CD
authors.lastname: Kim
authors.forename: Ho Sang
authors.initials: HS
authors.lastname: Ryu
authors.forename: Yang-Seok
authors.initials: YS
authors.lastname: Chae
mesh_terms: D001329:Autolysis / Q000209:etiology* / Q000473:pathology; D004210:Dissection / Q000009:adverse effects*; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000009:adverse effects*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*