Endoscopic mucosal resection

Overview

Endoscopic mucosal resection (EMR) is a minimally invasive procedure used to remove abnormal tissue from the digestive tract, also known as the gastrointestinal (GI) tract. This series of organs facilitates food digestion and nutrient absorption. EMR offers a less invasive alternative to open surgery, resulting in reduced pain and quicker recovery times.

During EMR, a gastroenterologist, specialized in GI diseases, utilizes a long, flexible tube equipped with a camera known as an endoscope. You receive sedation before the procedure begins. The endoscope is then inserted through either the mouth or anus, depending on the location of the abnormal tissue within the digestive tract. Surgical instruments passed through the endoscope allow precise removal of the irregular tissue.

Reasons for undergoing the procedure

Endoscopic mucosal resection is typically performed to treat precancerous growths, such as polyps or lesions, or early-stage malignancy. For cancers that form in the mucosa, the inner membrane lining your gastrointestinal tract, gastroenterologists employ endoscopic mucosal resection.

Generally speaking, endoscopic mucosal excision is done to treat:

• Esophageal cancer.
• Stomach cancer.
• Small intestine cancer, including duodenal cancer.
• Colorectal cancer.
• Barrett’s esophagus, which can lead to the formation of precancerous lesions.

If you have a small tumor or precancerous lesion, you might be a candidate for endoscopic mucosal resection. Larger tumors could need additional therapies, such as:

• Chemotherapy.
• Radiation therapy.
• Surgery.
• Endoscopic submucosal dissection to remove tumors that have invadedinto your gastrointestinal tract’s deeper layers.

Risks

Although complications from endoscopic mucosal resection are uncommon, they may include:

• Bleeding
• Gastrointestinal perforation
• Esophageal scarring, which may result in esophageal strictures

Before the procedure

Your gastroenterologist will give you specific instructions to prepare for an endoscopic mucosal resection (EMR). If the procedure targets the upper gastrointestinal tract, which includes the esophagus, stomach, or small intestine, you will need to fast for several hours beforehand.

For procedures focusing on the lower GI tract, such as the large intestine (colon and rectum), you may need to undergo bowel preparation. This typically involves taking laxatives to thoroughly cleanse your colon, ensuring optimal visibility for your gastroenterologist during the procedure.

During the procedure

To ensure your comfort and relaxation during the procedure, you will receive anesthesia. This could involve general anesthesia, which induces sleep, or conscious sedation, where you remain awake but have no memory of the procedure afterwards.

During the endoscopic mucosal resection (EMR), your gastroenterologist will:

• Insert the endoscope either through the mouth for upper GI procedures or through the anus for lower GI procedures.
• Direct the endoscope toward the abnormal tissue.
• Use surgical instruments passed through the endoscope to remove the irregular tissue. Techniques may include suction, solution injection, or electric wire cutting.

The procedure typically lasts between thirty and sixty minutes.

After the procedure

Your gastroenterologist might send a sample of the abnormal tissue to a lab, where a pathologist (a doctor specializing in examining body tissue) will analyze it for any signs of disease.

After the procedure, you’ll be taken to a recovery room to wait for the anesthesia to wear off. Since it can take up to 24 hours for the anesthesia’s effects to fully dissipate, you will need someone to drive you home.

Depending on the treated area, you might experience some mild to moderate side effects for a day or two, which could include:

• Sore throat
• Nausea
• Vomiting
• Bloating
• Cramping
• Gas pain or overproduction of gas

Outcome

Following endoscopic mucosal resection, most individuals can resume work the day after the procedure. However, you may need to adhere to a liquid diet for a few days to allow your digestive tract to heal.

Typically, a follow-up appointment with your gastroenterologist is scheduled within 12 weeks post-procedure. During this visit, the gastroenterologist will use an endoscope to examine your digestive tract and confirm the complete removal of abnormal tissue. Depending on the findings, additional examinations or treatments may be recommended.