Endoscopic Mucosal Resection

Endoscopic Mucosal Resection (EMR)

Gastrointestinal endoscopic mucosal resection (EMR) is a procedure to remove early-stage cancer and precancerous growths from the lining of the digestive tract.

Endoscopic mucosal resection is performed with an endoscope, which is a long, narrow tube equipped with a light and video camera. During EMR of the upper digestive tract, the doctor passes this tube (endoscope) through your mouth into your esophagus, stomach or upper part of the small intestine (duodenum). To reach the colon, the doctor guides a scope up through the anus. The doctor then inserts instruments through the endoscope to perform the procedure.

In most situations, EMR is intended to treat and cure a growth whether it is benign, precancerous or early stage (superficial) cancer. EMR can also be used for precise and accurate staging of gastrointestinal cancers.  Examination of the tissue that is removed can help your doctor make a definitive diagnosis. For example, if you have cancer, EMR can help determine if the cancer has spread beneath the digestive tract lining, which would require a different method of treatment.

Reasons for the Procedure

Endoscopic mucosal resection is a less invasive alternative to surgery for removing abnormal tissues from the lining of the digestive tract. Your doctor may recommend the procedure to remove certain early-stage cancers or precancerous growths.

Some of the conditions that EMR has been used to treat include:

  • Barrett’s esophagus
  • Esophageal cancer
  • Precancerous growths and polyps of the stomach
  • Stomach (gastric) cancer
  • Precancerous polyps of the small intestine
  • Colon polyps
  • Colorectal cancer
  • Noncancerous growths that cause symptoms such as difficulty swallowing, nausea and vomiting, gastrointestinal bleeding

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

Preparation

Before you have an endoscopic mucosal resection, your doctor will want to know your health history and the medications you use.

You’ll be asked to provide the following information:

  • The names and doses of all prescription medications, over-the-counter drugs and dietary supplements you take — especially diabetes medications and blood-thinning drugs, including aspirin
  • Whether or not you have or ever had a drug allergy and, if so, the name of the drug
  • All medical conditions you have, especially heart disease, lung disease, diabetes and blood-clotting disorders
  • Food and medications

You’ll receive written instructions about what to do the day before the procedure, including:

  • You may not be able to eat or drink for many hours before the procedure. This is called fasting. Often, fasting begins at midnight before your procedure, but the specific start time can vary. You’ll be instructed when to begin. You may also not be able to smoke or chew gum during this time.
  • Waiting to take certain medications. Your doctor may ask you to temporarily stop taking some medications, such as those that affect blood clotting or some medications for diabetes.

Results

You will have a follow-up with the gastroenterologist to discuss the outcome of your endoscopic mucosal resection and the results of any laboratory tests performed on tissue samples. Questions to ask your doctor include:

  • Were you able to remove all abnormal tissue?
  • What were the results of the laboratory tests? Do I have cancer?
  • Do I need to see a cancer specialist (oncologist)?
  • If I have cancer, will I need additional treatments?
  • How will you monitor my condition?
  • Is there anything I can do to decrease my chances for developing another growth?

Benefits

The greatest benefit of EMR is that in most instances curative treatment can be achieved without the need for surgery. When performed by experts, EMR is both safe and effective. In most instances, patients are able to return home the day of the procedure and resume normal activities much sooner than after surgery, which would be a more invasive and higher risk alternative. Most patients do not experience pain or discomfort after EMR.

Risks

Risks of the endoscopic mucosal resection include:

  • Sometimes bleeding can occur during the healing process and sometimes this can require additional treatment. This most common complication often can be detected and corrected during the procedure. 
  • 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 is removed. In most instances, perforation can be treated with endoscopic clips or sutures.
  • Narrowing of the esophagus. Removing certain esophagus lesions increases the risk of scarring that narrows the esophagus, which may lead to difficulty swallowing and require further treatment such as additional endoscopy with dilation or stretching of the narrow area.
  • A small percentage of growths can reappear and may require additional treatment. Careful follow-up typically results in situations where additional endoscopic treatment would be curative.