Gastrointestinal EMR

A procedure to remove abnormal tissues (lesions) and cancerous tissues from the digestive tract is called gastrointestinal endoscopic mucosal resection (EMR).

This procedure is done with a long and narrow tube that has a light and video camera, during this procedure, the endoscope is passed down your throat to reach an abnormally in your stomach, esophagus or upper part of the small intestine or duodenum.

The tube is then guided up through the anus to remove the lesions from the colon. EMR can help determine if cancer if cancer invaded tissues beneath the digestive tract lining and this procedure is also used to collect tissues for diagnosis.

Here are the most common reasons for an endoscopic mucosal resection.

EMR is a less invasive alternative to surgery in removing abnormal tissues from the lining of the digestive tract.

Some of the tissues might be precancerous lesions that may become cancerous; early-stage cancer.

A gastroenterologist who specializes in digestive tract disorders will perform the procedure.

Some of the possible risks of endoscopic mucosal resection include:

• puncture or perforation – through the wall of the digestive tract depending on the location and size of the lesion that is removed
• bleeding – this is the most common complication and can often be corrected or detected during the procedure
• narrowing of the esophagus – the lesion that is circling the esophagus will be removed because it can carry the risk of scarring that will narrow the esophagus which can lead to difficulty in swallowing

Consult your doctor if you are experiencing symptoms after undergoing EMR such as:

• chills
• fever
• black stool
• vomiting
• abdominal or chest pain
• bright red blood in the stool
• fainting
• shortness of breath

To prepare for the endoscopic mucosal resection you will be asked by your doctor to provide information such as:

• all the medications, supplements, and vitamins that you are taking including their doses
• if you have drug allergies
• all your medical conditions such as heart disease, lung disease or diabetes

He may ask you to stop taking your medications first and you will be given instructions on what you should do a day before the procedure.

The instructions include:

• fasting – you may not eat, chew, drink or smoke after midnight before the procedure
• cleaning the colon – you will be given liquid laxative or an over-the-counter enema kit to clean your colon and empty your bowels

Your doctor may instruct you to sign a consent document giving him permission to perform the procedure after the benefits and risks were explained to you.

You can ask your doctor if something is not clear to you. You will be sent home after the procedure but you should be accompanied by a family member or a friend because you have been sedated.

Here you can find out what to expect from your endoscopic mucosal resection procedure.

There are versions of EMR, you can ask your doctor how this procedure will be done.

A common method includes:

• inserting the endoscope and guiding the tip to the area of concern
• inserting a fluid under a lesion to create a cushion between the healthy tissue and lesion
• lifting the lesion using a gentle suction
• cutting the lesion to separate it from healthy tissues
• removal of the abnormal tissue; marking the area with ink (tattoo) so it can be seen again for endoscopic exams in the future

In an EMR, you can expect:

• you will be asked to change into a gown and will be asked to lie down on a cushioned table
• you will be given local anesthetic, if the endoscope is going to be inserted in your throat it will be sprayed or you will gargle a solution to numb the throat
• you will be sedated during the procedure which you may feel drowsy and relaxed, you will not feel pain but you may feel slight movements or pressure
• you will be monitored by nurses and other professionals especially your heart rate, blood oxygen level and blood pressure

After the procedure, you will remain in the recovery room until the sedative has worn off and you will be given instructions on when to start eating and drinking.

You will be advised to avoid doing things the next day such as driving, make important decisions, return to work.

Mild side effects may occur within 24 hours after the procedure such as:

• you may experience vomiting, nausea, and drowsiness due to the sedative
• you may have a sore throat if the endoscope was guided down your throat
• you may have cramps, gas or bloating if air was pumped into your digestive system

Some of the possible symptoms that suggest complications from EMR include:

• chills
• fever
• black stool
• vomiting
• fainting
• shortness of breath
• bright red blood in the stool
• chest or abdominal pain

Mostly you will have a follow-up appointment with your gastroenterologist to discuss the results of the endoscopic mucosal resection and the laboratory exams.

Some of the questions that you can ask your doctor include:

• Are the abnormal tissues have been removed?
• Was any of the tissues cancerous?
• What were the results of the laboratory exams?
• Do I need to see an oncologist?
• Will I need additional treatments if the tissues are cancerous?
• How will you monitor my condition?

Three to 12 months after the procedure there will be a follow-up exam to check if the entire lesion was removed. You will have further examinations based on the findings of your doctor.

He will have a visual inspection and will tattoo the area where the lesion is removed so that he will know if the lesion was removed completely.