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Endoscopic Mucosal Resection

What is Endoscopic Mucosal Resection (EMR)?

Endoscopic mucosal resection is a minimally invasive surgical procedure for the resection (removal) of early-stage cancerous cells (neoplasms) or any other superficial abnormal tissues also called lesions, from your digestive tract, usually the oesophagus or colon.

EMR is performed using an endoscope which is a thin tubular instrument with a camera, light, and a magnifying lens attached at the end. EMR can be used both as a diagnostic procedure to view the abnormalities in the lining of your gastrointestinal tract, and can also serve as a minimally invasive treatment procedure to remove the cancerous cells.

What are the Indications for Endoscopic Mucosal Resection (EMR)?

Endoscopic mucosal resection is recommended for the removal of:

  • Early-stage gastrointestinal cancer
  • Gastrointestinal lesions which may become cancerous
  • Barrett's oesophagus: Change in the lining of the oesophagus due to reflux of the gastric contents
  • Oesophagal adenocarcinoma: Cancer of the oesophagus (food pipe) 
  • Polyps in the stomach, rectum, or colon

Pre-Surgical Preparation for Endoscopic Mucosal Resection (EMR)

Presurgical preparation for endoscopic mucosal resection involves the following steps:

  • A thorough examination by your gastroenterologist to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your age and medical history, you may be required to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
  • Inform your doctor about your:
    • Allergies
    • Current medications, vitamins, or supplements
  • Refrain from:
    • Medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
    • Tobacco, smoking and drinking at least a week before and two weeks after surgery.
  • Do not consume solid food or liquids at least 8 hours prior to surgery.
  • Arrange for someone to drive you home after the procedure.
  • You will be given a laxative if your doctor intends to perform EMR through the colon.

Endoscopic Mucosal Resection (EMR) Procedure

Endoscopic mucosal resection is performed as an outpatient procedure. It may take around 1-2 hours.

  • You are required to change into a surgical gown or drape. 
  • You will lie on the operating table on your side, preferably on the left.
  • The endoscope is inserted into your gastrointestinal tract either via your mouth or through the rectum. 
  • If the endoscope is inserted through your mouth, a local anaesthetic is sprayed inside your throat or you may be asked to gargle a solution to numb your throat and avoid a gag reflex while the endoscope is being inserted.
  • A sleep-inducing medication (sedative) may also be administered to keep you comfortable during the procedure.
  • You may feel slight movement or pressure during the procedure, but you won’t feel pain.
  • Your blood pressure, oxygen level, and pulse are monitored continuously before, during, and after the procedure.
  • After placing the endoscope into the targeted area, a special solution is injected under and around the tumour cells that helps to raise them to form a blister.
  • This allows your doctor to remove the cancer cells/gastrointestinal lesion without damaging the rest of the oesophagus or colon and minimize bleeding.
  • Suction may be applied to further lift the blister and pull it away from surrounding gastrointestinal tissue. 
  • A thin wire loop is slipped over the blister, and an electric current is passed through the wire. This cuts the blister and helps to seal the wound. 
  • Once the blister is free, it's scooped up in a small wire basket and removed from the digestive tract.
  • Then, the endoscope is removed.

Post-surgical Care for Endoscopic Mucosal Resection (EMR)

You are required to stay in the hospital for a few hours until the effect of the anaesthesia and sedative has reduced. Once you are feeling comfortable and able to walk properly, you will be discharged.

You may be advised to consume a liquid diet for 1 to 2 days after the procedure and gradually shift to soft or pureed food for the next 2 days. Your doctor will give you specific instructions about when you can resume your regular activities.

Some of the common side effects within 24 hours of the procedure may include:

  • Drowsiness
  • Sore throat
  • Nausea and vomiting
  • Chest discomfort 
  • Bloating cramps or gas

These are normal and will subside gradually. You may be prescribed medications for pain relief to reduce discomfort and help in quicker recovery.

What are the Risks and Complications of Endoscopic Mucosal Resection (EMR)? 

Endoscopic mucosal resection is a relatively safe and painless procedure. However, you must call your doctor if you experience any of the following:

  • Severe chest or abdominal pain
  • Shortness of breath
  • Fever
  • Chills
  • Vomiting
  • Black stool or specks of blood in your stool
  • Unconsciousness 

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