Endoscopic Mucosal Resection Procedure
Overview
Endoscopic mucosal resection (EMR) removes abnormal tissue, such as early cancers or lesions, from inside the digestive tract. Medical teams use an endoscope—a thin, flexible tube with a light and camera—to see inside the body without large incisions. The endoscope passes through the mouth to reach areas like the esophagus, stomach, or duodenum, or a colonoscope enters through the anus to access the colon.
Main Uses and Methods:
- Treatment of early-stage cancer
- Removal of precancerous or unusual growths
- Collection of tissue for laboratory analysis
Some other advanced techniques include Endoscopic Submucosal Dissection (ESD) and endoscopic full-thickness resection (EFTR). Underwater EMR and mucosectomy may also be used, depending on the case. In gastroenterology, these methods are valued because they are minimally invasive, helping to reduce recovery times compared to traditional surgery.
| Technique | Purpose |
|---|---|
| EMR | Removes superficial lesions |
| ESD | Takes out deeper growths |
| EFTR | Treats complex lesions |
This range of endoscopic procedures allows medical teams to remove problematic tissue precisely and helps patients avoid more invasive operations.
Reasons for the Procedure
Doctors recommend EMR for several reasons, including:
- Removing early-stage cancers in the esophagus, stomach, or colon.
- Eliminating polyps that cannot be removed by standard polypectomy due to size or location.
- Treating high-grade dysplasia or abnormal mucosal growths before they turn into invasive cancer.
- Evaluating lesions seen on imaging or suspected from biopsy as part of a diagnostic plan.
- Avoiding more invasive surgery when possible, especially in elderly or high-risk patients.
Possible Complications
Endoscopic mucosal resection (EMR) may cause several side effects or complications. Bleeding is the most common risk, and it can happen during or after the procedure. Medical teams can usually find and manage bleeding quickly, but sometimes delayed bleeding happens later. Perforation, or puncturing the digestive tract wall, is a less common but serious concern.
The risk depends on the size and location of the lesion doctors remove. Another possible issue is narrowing of the esophagus, also called stricture formation. When doctors treat a large area or an entire section around the esophagus, scar tissue may cause the esophagus to become more narrow.
This can make swallowing difficult and sometimes lead to other treatments. Other possible symptoms include bloating, cramping, excessive gas, a sore throat, or vomiting. Some patients might notice black stools or vomit that looks like coffee grounds due to bleeding. In rare cases, submucosal fibrosis or other adverse events may occur.
List of Warning Signs to Report:
- Fever or chills
- Worsening chest or stomach pain
- Trouble swallowing
- Bright red blood in stool or vomit
- Dizziness or fainting
- Shortness of breath
Contact a healthcare professional if any of these signs appear.
Getting Ready for Your Procedure
Before an endoscopic mucosal resection, patients need to follow several steps to make sure the procedure goes smoothly. This reduces risks and makes recovery easier.
Medication Review: Patients should share a complete list of all prescription medicines, over-the-counter drugs, and supplements they take. This includes details about medicines for chronic conditions, such as blood thinners or diabetes medications. Some medicines may need to be stopped or adjusted to prevent problems with bleeding or reactions with sedatives or anesthesia.
Allergy and Health History: Patients must tell the care team about any allergies, especially to medicines, and about all past and current health conditions. Diseases like heart issues, lung problems, or blood-clotting disorders may affect how the procedure is performed or how sedation is given.
Dietary Steps Before the Procedure: Patients usually receive detailed written instructions about eating and drinking. Many must stop eating and drinking for a certain time, often starting the evening before the procedure. This is called fasting. Sometimes doctors recommend a clear liquid diet—mainly water, broth, and clear juices—beforehand.
Bowel Preparation: If the procedure involves the colon, patients must clean it out beforehand. A special liquid laxative or an enema kit may be used. These help empty the bowels to give the doctor a clear view during the colonoscopy.
| Step | What to Do | Examples |
|---|---|---|
| Fasting | Stop eating/drinking | Usually after midnight |
| Liquid Diet | Only clear drinks | Water, broth, clear juice |
| Bowel Prep | Laxative or enema | As directed by doctor |
- Consent Process: Before starting, patients sign a consent form that explains the risks and benefits. This is also a good time to ask the healthcare team any questions.
Planning How to Get Home
Medical teams give patients sedatives or general anesthesia to help them feel relaxed or sleepy during the procedure. These medicines take time to wear off and may affect judgment, reflexes, and balance. For safety, patients cannot drive themselves home afterward.
Arrange for a trusted friend or family member to take you home. In some situations, if you are not fully alert or have other medical needs, the care team may ask you to stay at the hospital longer for observation.
Tip: Bring a contact number for your ride and let them know about possible delays in case the procedure takes longer than expected. This helps the process go as smoothly as possible.
What You Can Expect
What Happens During the Procedure
The endoscopic mucosal resection (EMR) usually begins with the patient changing into a gown and lying on their side on a soft table. A gastroenterologist uses either a flexible endoscope or a colonoscope, depending on whether the abnormal tissue is in the upper or lower parts of the gastrointestinal (GI) tract. The scope may be used in the esophagus, stomach, small intestine, colon, or rectum.
Before the procedure, medical staff may numb the throat with a spray or gargle if the endoscope needs to pass through the mouth. This reduces discomfort as the scope moves through the esophagus. Medical staff give medicine to help patients relax or make them sleepy. Some patients are lightly sedated and can respond when spoken to, while others sleep more deeply to prevent pain and anxiety.
The decision depends on each patient’s condition and the approach the gastroenterologist recommends. Healthcare staff closely monitor vital signs—heart rate, breathing rate, blood oxygen, and comfort level—throughout the EMR. The endoscope, fitted with a small camera and light, is carefully inserted and guided to the area of concern somewhere in the digestive tract.
The doctor injects a special solution, often saline, beneath the lesion or polyp to form a protective cushion. Sometimes, other medications like epinephrine are included to help stop any potential bleeding (hemostasis). This fluid separates the mucosa (lining) from deeper tissue, usually the submucosa, lowering the risk of injury.
In some cases, the doctor applies gentle suction to lift the abnormal growth. A thin wire loop (snare) is then positioned around the base of the tissue. The doctor passes electricity (diathermy or electrocautery) through the wire to cut and seal the area at the same time. Medical staff collect the removed tissue in a small basket and send it to a lab for further evaluation.
After removing the abnormal tissue, the doctor may use a marking dye (sometimes called “ink marking”) to highlight the area. This marking helps gastroenterologists find the same spot during future check-ups or endoscopic ultrasound (EUS) studies.
Quick Summary Table: Main Steps in EMR
| Step | Purpose |
|---|---|
| Anesthetics/Sedation | Reduces pain and anxiety. |
| Endoscope insertion | Allows viewing inside the digestive tract. |
| Submucosal injection | Creates cushion and protects deeper tissues. |
| Suctioning/Lifting | Helps separate the lesion from the healthy lining. |
| Loop excision with diathermy | Removes lesion while sealing area. |
| Area marking | Easy location for a future endoscopy. |
What to Expect Shortly After the Procedure
Recovery from this minimally invasive GI treatment generally takes place in a special area, often called a recovery room. Medical staff monitor the patient as the sedative wears off. Most people rest for a short time before going home. Common symptoms during the hours after EMR are usually minor.
Some people experience drowsiness or lightheadedness due to the anesthesia or sedative medications. Others have a slightly sore throat if the endoscope passed through the mouth and esophagus. Since air is often pumped into parts of the digestive tract (like the colon or stomach) for a better view during endoscopy, mild gas, cramping, or bloating can occur.
Patients receive clear, written guidelines on how soon they can eat, drink, and resume normal activities. Most can return to regular routines fairly quickly. Food, drink, or activity may be limited for a short time, especially if the procedure was in the upper GI tract or involved a large area of tissue.
Common Mild After-Effects
- Drowsiness
- Nausea or queasiness
- Throat discomfort
- Gas, bloating, or cramping
Patients receive a detailed sheet listing symptoms that should prompt calling a healthcare provider or seeking urgent care. Rare but serious complications to watch for include:
- Fever or chills
- Vomiting that looks like coffee grounds or contains blood
- Black or bloody stool
- Chest, stomach, or throat pain that gets worse
- Difficulty swallowing
- Shortness of breath or fainting
Awareness of these warning signs ensures that issues like bleeding, infection, or injury to the digestive tract are caught and treated as early as possible. The tissue removed during the procedure is examined closely in a laboratory to check for cancer or other changes.
Pathology results usually guide any further care or follow-up. Because the GI tract includes many parts—such as the esophagus, stomach, small intestine, colon, and rectum—follow-up plans can vary depending on where the EMR occurred and the findings.
Findings
Patients usually have a follow-up checkup with a gastroenterologist about 3 to 12 months after endoscopic mucosal removal. During this visit, the doctor reviews the results of the procedure, including lab reports that a pathologist prepares. These reports indicate whether the removed tissue samples showed cancer or precancerous changes.
During the checkup, the doctor often performs another endoscopy to inspect the area where the tissue was removed. The doctor looks for any signs of new or returning growths (local recurrence) and checks if any abnormal tissue remains.
If the doctor finds cancer, the healthcare team may discuss possible next steps, such as referring the patient to an oncologist or recommending more treatment like surgical resection. The team determines the need for further exams or scans, such as to check for distant spread (metastases), based on their findings.
| Aspect | Details |
|---|---|
| Who reviews samples | Pathologist |
| Key concerns | Prognosis, local recurrence, distant metastases, need for more treatment |
| Tools used | Endoscope, tissue sample analysis |
Doctors guide patients on questions to ask, including test results, possible need for more doctors, and plans for ongoing monitoring.
