Endoscopic mucosal resection

Endoscopic mucosal resection (EMR) is a technique to remove irregular tissue from the digestive tract. EMR can remove early-stage cancer, tissue that may become cancer or other tissues that aren't typical, called lesions. Healthcare professionals do endoscopic mucosal resection using a long, narrow tube called an endoscope. The endoscope is equipped with a light, video camera and other tools. During EMR of the upper digestive tract, healthcare professionals pass the endoscope down the throat. They guide it to lesions in the esophagus, stomach or upper part of the small intestine, called the duodenum.

Endoscopic mucosal resection can remove irregular tissues from the lining of the digestive tract without making cuts through the skin or removing a part of the gut. This makes EMR a less invasive treatment choice than surgery. Compared with surgery, EMR is linked with fewer health risks and lower costs. Tissues removed with EMR may be: Early-stage cancer. Lesions that may become cancer, also called precancerous lesions or dysplasias. Most often, a doctor called a gastroenterologist does endoscopic mucosal resections. This type of doctor finds and treats conditions of the digestive system. If you need to have EMR, try to choose a gastroenterologist who has lots of experience doing the procedure.

Risks of endoscopic mucosal resection include: Bleeding. This is the most common concern. Healthcare professionals can find and fix bleeding during or after EMR. Narrowing of the esophagus. The esophagus is the long, narrow tube that runs from the throat to the stomach. Removing a lesion that encircles the esophagus carries a risk of scarring that narrows the esophagus. This narrowing may lead to trouble swallowing, and more treatment may be needed as a result. Puncture, also called perforation. There's a small chance that endoscopy tools could puncture the wall of the digestive tract. The risk depends on the size and location of the lesion that's removed. Call your healthcare professional or get emergency care if you notice any of the following symptoms after EMR: Fever. Chills. Vomiting, especially if the vomit looks like coffee grounds or has bright red blood in it. Black stool. Bright red blood in the stool. Pain in the chest or stomach area. Shortness of breath. Fainting. Trouble swallowing or throat pain that becomes worse.

Before you have endoscopic mucosal resection, your healthcare team asks you for the following information: All medicines and dietary supplements you take and their doses. For instance, it's important to list any blood-thinning medicines, aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve), iron supplements, and medicines for diabetes, blood pressure or arthritis. Any medicine allergies. All health conditions you have, including heart disease, lung disease, diabetes and blood-clotting disorders. Your healthcare professional may ask you to stop taking some medicines for a short time before EMR. This includes medicines that affect blood clotting or those that interfere with medicines called sedatives that help you relax before EMR. You receive written instructions about what to do the day before your EMR. These instructions may vary depending on the location of the lesion or lesions being removed. In general, the instructions likely will include: Fasting. You're told how soon to stop eating and drinking, also called fasting, before the EMR. You may not be able to eat, drink, chew gum or smoke after midnight before the EMR. You may be asked to follow a clear liquid diet the day before your procedure. Cleaning the colon. If the EMR involves the colon, you'll take some steps to empty your bowels and clean your colon beforehand. To do this, you may be told to use medicine called a liquid laxative. Or you might use a device called an enema kit that sends water into the rectum. You'll also sign an informed consent form. This gives your healthcare professional permission to do the EMR after the risks and benefits have been explained to you. Before you sign the form, ask your healthcare professional about anything you don't understand about the procedure.

There are a few versions of endoscopic mucosal resection. Ask your gastroenterologist about how your EMR will be done. 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 tissue that isn't typical from within the body. Marking the treated area with ink so that it can be found again with future endoscopic exams.