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.