Endoscopic Mucosal Resection (EMR)

What is EMR?

Gastrointestinal endoscopic mucosal resection (EMR) is a procedure to remove cancerous or other abnormal tissues (lesions) from the digestive tract.

Endoscopic mucosal resection is performed with a long, narrow tube equipped with a light, video camera and other instruments. During EMR of the upper digestive tract, the tube (endoscope) is passed down your throat to reach an abnormality in your esophagus, stomach or upper part of the small intestine (duodenum).

To remove lesions from the colon, the tube is guided up through the anus.

Primarily a treatment procedure, EMR is also used to collect tissues for diagnosis. If cancer is present, EMR can help determine if the cancer has invaded tissues beneath the digestive tract lining.

Why is EMR done?

Endoscopic mucosal resection is a less invasive alternative to surgery for removing abnormal tissues from the lining of the digestive tract. These tissues may be:

• Early-stage cancer
• Precancerous lesions, which may become cancerous

Endoscopic mucosal resection is usually performed by a specialist in digestive system disorders (gastroenterologist) who has expertise in this technique.

What are the risks of EMR?

Risks of the endoscopic mucosal resection include:

• This most common complication often can be detected and corrected during the procedure.
• Puncture (perforation).There is a slight risk of a puncture through the wall of the digestive tract, depending on the size and location of the lesion that’s removed.
• Narrowing of the esophagus.Removing a lesion that encircles the esophagus carries some risk of scarring that narrows the esophagus, a condition that may lead to difficulty swallowing and require further treatment.

Call your doctor or get emergency care if you develop any of the following signs or symptoms after undergoing endoscopic mucosal resection:

• Fever
• Chills
• Vomiting
• Black stool
• Bright red blood in the stool
• Chest or abdominal pain
• Shortness of breath
• Fainting

What you can expect with an EMR?

There are a few versions of endoscopic mucosal resection. Ask your gastroenterologist about how your procedure will be performed. A common approach includes these steps:

• Inserting the endoscope and guiding the tip to the area of concern
• Injecting a fluid under a lesion to create a cushion between the lesion and healthy tissue underneath it
• Lifting the lesion, possibly using gentle suction
• Cutting the lesion to separate it from surrounding healthy tissue
• Removing the abnormal tissue from your body
• Marking the area with ink (tattoo) so that it can be found again with future endoscopic exams

During the procedure

During an endoscopic mucosal resection, you can expect the following:

• Your role.You’ll be asked to change into a gown before the procedure. During the procedure, you’ll lie on your side on a cushioned table.
• Local anesthetic.If the endoscope is inserted through your throat, you may have your throat sprayed or be asked to gargle a solution to numb your throat to make insertion of the endoscope more comfortable.
• You’ll be sedated during the procedure. With moderate sedation that causes you to be relaxed and drowsy, you may feel slight movement or pressure during the procedure, but you shouldn’t feel pain. Or you may be heavily sedated. Discuss with your gastroenterologist which option is appropriate for you.
• Nurses or other professionals will monitor your heart rate, blood pressure, blood oxygen level and comfort while the doctor performs the procedure.

After the procedure

You’ll remain in a recovery room until most of the effect of the sedative has worn off. You’ll receive written instructions about when you can start eating and drinking and when you can resume normal activities. You’ll be advised not to do any of the following activities until the next day:

• Drive
• Return to work
• Make important decisions

Relatively mild side effects may occur within 24 hours after the procedure including:

• Reactions to the sedative.You may continue to feel drowsiness and may experience nausea and vomiting.
• Sore throat.If the endoscope was guided down your esophagus, your throat may be sore.
• Gas or cramps.If air was pumped into your digestive system to make it more accessible, you may have gas, bloating or cramps after the procedure.

You’ll also receive written instructions about when to call your doctor or get emergency care after the procedure. The following signs or symptoms may indicate a serious complication from endoscopic mucosal resection:

• Fever
• Chills
• Vomiting
• Black stool
• Bright red blood in the stool
• Chest or abdominal pain
• Shortness of breath
• Fainting

What follow-up exams are needed after an EMR?

Typically, a follow-up exam is performed three to 12 months after your procedure to be sure the entire lesion was removed. Depending on the findings, your doctor will advise you about further examinations.

An exam will likely include a visual inspection with the use of an endoscope. Your doctor may mark the area of the removed lesion with ink (tattoo) so that when follow-up endoscopy is performed, he or she can be sure the lesion was removed completely.