Endoscopic Mucosal Resection

Endoscopic mucosal resection (EMR) is a nonsurgical outpatient procedure used to remove cancerous cells and abnormal tissues from the digestive tract. It is often used to diagnose and treat Barrett’s esophagus Barrett’s esophagus, esophageal cancer, stomach cancer, and large colon polyps, or flat lesions in the colon. If cancer is present, EMR can help determine the stage of growth and if the cancer has spread.

Endoscopic mucosal resection is a safer, less invasive alternative to surgery for:

• Obtaining a larger biopsy sample (about the size of a penny, which is four to five times larger than a typical biopsy)
• Removing precancerous lesions or early-stage cancer tissues from the lining of the digestive tract

How to Prepare for an Endoscopic Mucosal Resection

If the procedure will be done through the mouth, you should not eat or drink anything after midnight prior to the procedure.

If the procedure will be done through the rectum, you will need to undergo bowel prep similar to preparing for a colonoscopy. Your doctor will provide you with specific instructions.

Your doctor will let you know if or when you should adjust or stop any medications you take. Because you will be sedated, you will need someone to drive you home after the procedure.

What to Expect

Endoscopic mucosal resection is performed during an upper endoscopy or a colonoscopy. You will receive pain-relieving medication and sedation through an IV line to relax you and make you feel drowsy.

For an EMR of the upper GI tract (esophagus, stomach, or upper part of the small intestine), the endoscope is inserted through the throat. A mouth guard will be placed to protect your teeth and gums. Your throat may also be numbed with a spray to calm the gag reflex. For an EMR of the lower GI tract (colon and rectum), the endoscope is inserted through the anus.

Using specialized instruments inserted through the endoscope, your doctor will first inject a liquid below the lesion or abnormal tissue to separate it from the healthy tissue underneath. He will then lift the lesion, cut it, and remove it from your body. Your doctor will repeat this technique to ensure all abnormal tissue is removed. Tissue samples are sent to the pathology lab for analysis. It may take several days to receive biopsy results.

Patients with early-stage esophageal cancer may also undergo an endoscopic ultrasound prior to an EMR to ensure there is no deeper tissue involvement.

Endoscopic mucosal resection typically takes 25-35 minutes. After the procedure, you will be taken to the recovery room while the sedative wears off. You may experience temporary discomfort, such as sore throat (if you had an upper endoscopy) gas, bloating, or cramps. Your doctor will discuss any unexpected side effects that may occur and a plan to address them.

Your doctor will review the results of your EMR and discuss treatment plan options with you during a follow-up appointment.