An Endoscopic Mucosal Resection (EMR) is a minimally invasive procedure used to remove abnormal tissues, such as polyps or early-stage cancers, from the lining of the digestive tract. During the procedure, a flexible endoscope equipped with a special tool is inserted through the mouth or anus to reach the affected area. The abnormal tissue is then carefully lifted and removed using the tool, allowing for examination under a microscope to determine if it is cancerous or precancerous. EMR is often performed as an outpatient procedure and can help prevent the progression of certain digestive tract conditions when detected early.
FAQs
EMR is typically performed to remove abnormal tissues, such as polyps or early-stage cancers, from the lining of the digestive tract to prevent the progression of these conditions, as well as to obtain tissue samples for further examination and diagnosis. More specifically, EMR is typically used to treat:
- Barrett’s esophagus, which may cause precancerous lesions.
- Early esophageal and colorectal cancer.
- Tumors less than 2 cm that have not penetrated the deeper layer of the intestine.
- Areas of abnormal tissue, precancerous lesions, or superficial cancerous tumors such as gastric or small bowel lesions with clear margins (can be separated from surrounding tissues).
Candidates typically include individuals who have been diagnosed with certain gastrointestinal conditions or abnormalities, such as large or flat polyps, early-stage cancers, or precancerous lesions, within the lining of the digestive tract. EMR may also be recommended for patients who have undergone previous procedures, such as colonoscopies, where abnormalities were detected but not fully removed. Additionally, individuals deemed unfit for traditional surgery due to age, health status, or anatomical considerations may be considered candidates for EMR as a less invasive alternative.
Candidates typically include individuals who have been diagnosed with certain gastrointestinal conditions or abnormalities, such as large or flat polyps, early-stage cancers, or precancerous lesions, within the lining of the digestive tract. EMR may also be recommended for patients who have undergone previous procedures, such as colonoscopies, where abnormalities were detected but not fully removed. Additionally, individuals deemed unfit for traditional surgery due to age, health status, or anatomical considerations may be considered candidates for EMR as a less invasive alternative.
By removing abnormal or precancerous tissue from the lining of the digestive tract, EMR reduces the risk of progression to more advanced stages of disease, such as cancer. Additionally, it can help alleviate symptoms associated with these lesions, such as bleeding, obstruction, or discomfort. It can also prevent the need for more invasive treatments, such as surgery. Compared to open surgery, endoscopic techniques offer multiple benefits, such as:
- Faster recovery
- Less pain
- Lower risk of complications
EMR is generally considered a safe procedure, but like any medical procedure, it carries some inherent risks. These include bleeding, perforation (tearing or puncturing) of the gastrointestinal wall, infection, adverse reactions to sedation or anesthesia, and in rare cases, damage to nearby structures or organs, such as the esophagus. The likelihood of experiencing these complications depends on various factors, including the size and location of the lesion being removed, the patient’s overall health status, and the skill and experience of the endoscopist. It should be noted, however, that major complications occur in less than one percent of patients.
The alternatives to EMR depend on the specific condition being treated and its severity. In some cases, if the abnormal tissue is small and easily accessible, it may be possible to monitor it over time with regular surveillance endoscopies to ensure it does not progress. Another alternative is surgical removal of the affected tissue, which may be necessary if the lesion is too large or difficult to access with an endoscope. Additionally, other minimally invasive procedures such as endoscopic submucosal dissection or radiofrequency ablation may be considered as alternatives. It is essential for patients to discuss all available options with their healthcare provider to determine the most appropriate course of action.
Your healthcare provider may ask you to follow a clear liquid diet for a day before the procedure and refrain from eating or drinking for a certain period beforehand. If they are treating your lower GI tract (large intestine, which includes your colon and rectum), you may need to complete a bowel prep, which involves taking laxatives to cleanse your colon. Your doctor may also ask you to stop taking certain medications, particularly blood thinners, in the days leading up to the procedure to reduce the risk of bleeding. It is important to inform your doctor about all medications, supplements, and medical conditions you have before the procedure. Additionally, you will need to arrange for someone to drive you home after the procedure, as the sedation used during EMR can temporarily impair your coordination and judgment.
While the procedure itself is not painful due to the anesthesia, patients may experience some discomfort or mild pain afterward, such as bloating, cramping, or a sore throat. However, these symptoms are usually temporary and can be managed with over-the-counter pain medication if needed.
After the procedure, you will be monitored in a recovery area until the sedative wears off, and you may experience some mild discomfort, bloating, or throat irritation. There may also be some minor bleeding or irritation at the site where the abnormal tissue was removed, but this is usually temporary and should resolve itself on its own. Most patients can return home the same day and resume their normal activities within a day or two.
It is important to follow your doctor’s post-procedure instructions carefully, including any dietary or activity restrictions. Call your doctor or get emergency care if you develop any of the following signs or symptoms:
- Fever
- Chills
- Vomiting
- Black stool
- Bright red blood in the stool
- Chest or abdominal pain
- Shortness of breath
- Fainting
It should be noted that overall, most patients tolerate EMR well and experience few if any complications.
A pathologist will examine the tissue samples obtained during the procedure to determine if there are any abnormalities, such as precancerous or cancerous cells. Biopsy results typically take a few days to a week to become available, depending on the specific lab processing time. The results will be communicated to you by your gastroenterologist or the medical team overseeing your care. Your doctor will then discuss these results with you and provide recommendations for any further treatment or follow-up care based on the findings.
In your discussion with your health provider, you should consider asking the following:
- Were you able to remove all abnormal tissues?
- What were the results of the laboratory tests? Were any of the tissues cancerous?
- Do I need to see a cancer specialist (oncologist)?
- If the tissues are cancerous, will I need additional treatments?
- How will you monitor my condition?
Yes. Your healthcare provider will likely recommend follow-up exams to monitor your condition and ensure the success of the procedure. The timing and frequency will depend on various factors, including the reason for the EMR, the findings during the procedure, and your overall health, but are likely to start about three months after the procedure. Follow-up exams may involve repeat endoscopies, imaging tests, or other procedures to assess healing and detect any recurrence of abnormal tissue. It is essential to attend all scheduled follow-up appointments as advised by your healthcare provider to ensure optimal recovery and ongoing management of your condition.