Endoscopic Mucosal Resection (EMR)

Endoscopic mucosal resection (EMR) is a minimally invasive endoscopic procedure used to remove cancerous or precancerous lesions from the gastrointestinal tract, particularly in the esophagus, stomach, and colon.

Indications

• Removal of early-stage cancers or high-grade dysplasia in the esophagus, stomach, or colon
• Treatment of Barrett's esophagus with high-grade dysplasia
• Removal of large polyps in the colon that cannot be removed by standard polypectomy techniques

Procedure

The EMR procedure involves the following steps:

1. The patient is given conscious sedation to relax and reduce discomfort during the procedure.
2. A flexible endoscope with a specialized attachment, such as a band ligator or a cap, is inserted through the mouth or rectum and guided to the lesion site.
3. The lesion is lifted away from the underlying tissue using a solution, such as saline or epinephrine, injected beneath it.
4. A specialized device, such as a snare or a band ligator, is used to remove the lesion.
5. The removed tissue is then retrieved and sent for histopathological examination to confirm the diagnosis.

Types of EMR

• Strip biopsy EMR: A technique that uses a specialized forceps to remove a strip of mucosa containing the lesion.
• Ligation EMR: A technique that uses a band ligator to constrict the base of the lesion, followed by removal with a snare or scissors.
• Cap-assisted EMR: A technique that uses a transparent cap attached to the end of the endoscope to lift and remove the lesion.

Risks and Complications

As with any invasive procedure, EMR carries risks and potential complications, including:

• Bleeding or hemorrhage
• Perforation of the gastrointestinal tract
• Infection or abscess formation
• Stricture or narrowing of the gastrointestinal tract

Post-Procedure Care

After EMR, patients are typically monitored for several hours to ensure that there are no immediate complications.

• Patient may experience mild discomfort, bloating, or gas after the procedure.
• A follow-up appointment is usually scheduled to review the histopathology results and assess the healing of the lesion site.

Frequently Asked Questions (FAQs)

What is Endoscopic Mucosal Resection (EMR)?
A minimally invasive procedure to remove cancerous or precancerous lesions from the mucous membrane.

Where is EMR typically performed?
In the gastrointestinal tract, including the esophagus, stomach, and colon.

Who performs EMR?
Gastroenterologists or surgeons with specialized training in endoscopy.

What type of anesthesia is used for EMR?
Conscious sedation or general anesthesia, depending on the location and size of the lesion.

How long does the EMR procedure take?
Typically 30 minutes to several hours, depending on the complexity of the case.

What are the benefits of EMR?
Minimally invasive, low risk of complications, and can be an alternative to surgery.

Are there risks associated with EMR?
Yes, including bleeding, perforation, and infection, although rare.

Can EMR be used to treat all types of gastrointestinal lesions?
No, it is typically used for superficial lesions, and the suitability of EMR depends on the size, location, and type of lesion.

Is EMR a cure for cancer?
It can be curative for early-stage cancers, but may not be sufficient for more advanced cases.

What follow-up care is required after EMR?
Regular endoscopic surveillance to monitor for recurrence or new lesions.