Endoscopic mucosal resection (EMR)

If you’ve recently found out you have tumors or lesions in your gastrointestinal wall, you may be a candidate for an endoscopic mucosal resection. This minimally invasive procedure helps remove pre-cancerous growths before they spread to other parts of your body.

What is endoscopic mucosal resection?

Endoscopic mucosal resection (EMR) is a procedure performed with an endoscope (a flexible tube equipped with a light and tiny camera). It checks for and removes abnormal tissue (a lesion) from your digestive tract. This can include the esophagus, stomach and upper part of the small intestine, or duodenum.

EMR can also be used to remove abnormal tissue from your colon by inserting the tube into the anus. The abnormal tissue removed during EMR is tested for cancer or precancerous conditions. Sometimes, the tissue is abnormal from Barrett's esophagus. EMR allows tissue to be removed without surgery.

What does EMR treat?

An endoscopic mucosal resection procedure aims to remove irregular tissues from the lining of your gastrointestinal wall with a small incision. It allows your provider to remove any cancerous or abnormal tissues without making a large incision or removing any sections of the digestive tract.

EMR procedures are used to treat early-stage cancers or precancerous growths like lesions or polyps. Gastroenterologists will use this procedure for tumors that grow in the inner lining of your gastrointestinal tract (GI), also known as the mucosa.

Endoscopic mucosal resection can also be used to treat:

• Dysplasia in the stomach or colon
• Barrett’s esophagus
• Colorectal cancer
• Esophageal cancer
• Small intestine cancer
• Stomach cancer

How to prep for an endoscopic mucosal resection procedure

Before an EMR, you may be asked to not eat or to drink only clear liquids. You may also need to clean out your colon as you would for a colonoscopy. You may need to avoid smoking and/or taking certain medications before EMR. It’s an outpatient procedure, and you’ll be sedated with medication given through a needle in your arm (intravenously, or IV). Any discomfort is minimal.

Your doctor may numb your throat with a spray before placing the endoscope in your mouth. You’ll lie on your side during the procedure. Sometimes, the endoscope needs to be inserted through the rectum. Using a camera in the endoscope that sends pictures to a computer, your doctor guides the endoscope to the area of the lesion. Then the lesion is removed using tools inserted through the endoscope. Finally, the area where the lesion was removed is marked with ink so it can be easily found during future exams.

What to expect from an EMR procedure

An endoscopic mucosal resection procedure takes around 30-60 minutes to complete. You’ll either receive general anesthesia or conscious sedation, where you’re awake for the procedure but won’t remember much. Generally, your gastroenterologist will insert an endoscope through your mouth, but if the procedure is being used for a lower GI issue, the tube will be inserted through the anus.

Your provider will then direct the endoscope toward the irregular tissue. They’ll detach the lesion or polyp by suctioning it out, injecting a saline solution or cutting it out with an electric wire. They’ll then retrieve the tumor and pull it out through the endoscope. Your gastroenterologist might want to send a sample of the tissue to pathology to run more tests.

What are the benefits of an EMR procedure?

The main benefit of an endoscopic mucosal resection procedure is that it allows for the removal of precancerous or cancerous cells without requiring invasive surgery. This means that the procedure can remove irregular tissue without making a large incision or removing a portion of your digestive tract. Other benefits include:

• Faster recovery times
• Less pain than other more intensive procedures
• Lower risk of complications
• Lack of scarring

What are the risks of an EMR procedure?

While complications from an EMR procedure are rare, they can still happen. Some of the risks include:

• Gastrointestinal perforation
• Esophageal scarring
• Bleeding
• Chest pain
• Small hole or perforation in your esophagus or rectum
• Narrowing of the esophagus or intestine
• Reactions to the sedative
• Sore throat

If you experience serious symptoms after your procedure such as fever, vomiting, bleeding or blood in your stool, you should contact your provider immediately or call 911.

Recovery from endoscopic mucosal resection

The procedure takes an hour or less, after which you’re monitored for an hour or two while the sedation medication wears off. Then you'll be released from the hospital to someone who can drive you home. You might have a sore throat or some bloating for a day or two. Later, your doctor will discuss the results of the EMR with you. If you have Barrett's esophagus, you may need additional treatment after EMR such as cryotherapy, radiofrequency ablation or surgery to remove your esophagus.

Your provider will discuss next steps with you, including any follow-up exams, or share pathology results as soon as they’re able.