Endoscopic Mucosal Resection (EMR)

What is Endoscopic Mucosal Resection (EMR)?

Endoscopic Mucosal Resection (EMR) is a minimally invasive procedure typically conducted by a skilled interventional gastroenterologist. This technique aims to remove early-stage cancers, precancerous growths, or abnormal tissues from the lining of the gastrointestinal tract, which includes the stomach, colon, and esophagus. It is also effective in treating lesions such as Barrett’s esophagus and flat polyps. See also Endoscopic Submucosal Dissection (ESD).

Preparing for EMR

Preparing for an EMR involves several essential steps. Typically, fasting for 8 to 12 hours is required to ensure the procedure goes smoothly. If you are taking medications, especially blood thinners, it’s important to make the necessary adjustments as advised by your physician. Additionally, arranging for someone to drive you home after the procedure is necessary as you will not be allowed to drive yourself . For procedures involving the lower gastrointestinal tract, such as the colon, a laxative bowel preparation is necessary. In contrast, upper gastrointestinal procedures, which involve the esophagus or stomach, require an empty stomach. Proper preparation is vital for the safe and precise removal of precancerous growths.

What to expect during your EMR procedure

During the procedure, an endoscope equipped with a camera is inserted either through the anus or the mouth. The physician injects fluid beneath the lesion, lifting it to create a protective buffer that safeguards the surrounding muscle layer from heat or injury. A wire snare is employed to cut away the lesion, often eliminating the need for traditional surgery. Another technique involves attaching a cap to the endoscope, which allows the tissue to be suctioned into the cap and securely captured. The procedure typically lasts between 30-60 minutes and most patients go home same day and return to normal activities quickly. This innovative approach minimizes recovery time and enhances patient comfort.

Endoscopic Submucosal Dissection (ESD)

Endoscopic Submucosal Dissection (ESD): A Minimally Invasive Approach

Endoscopic submucosal dissection (ESD) is a minimally invasive procedure that preserves organ function and is utilized for treating early-stage gastric cancer. This technique enables gastroenterologists to remove tumors in one complete piece by injecting fluid beneath the lesion and employing an electrosurgical knife to carefully separate the growth from the underlying stomach or intestinal muscle.

ESD is typically reserved for early stage gastric cancer confined to the superficial mucosa or submucosa (tissue layers that line major organs like the stomach and intestines) where there is a lower risk of it having spread to the lymph nodes.

Compared to traditional surgical gastrectomy or conventional endoscopic mucosal resection (EMR), ESD provides significant clinical benefits.

Advantages

Precise Pathology: ESD allows the surgeon to remove the lesion in one piece, regardless of size, allowing pathologists to accurately stage the cancer

Reduced Recurrence: By removing the entire lesion, it dramatically lowers the risk of local recurrence by roughly 80% compared to EMR.

Organ Preservation: It avoids the removal of part or all of the stomach, drastically reducing hospitalization times and preserving normal digestive function.

What to expect during your EMR procedure

The procedure is typically performed by an advanced endoscopic interventionalist on an outpatient basis under sedation and generally takes 1 to 3 hours. Most patients are able to return to normal activities or work within about five days.