What is EMR (endoscopic mucosal resection) and why is it performed?

EMR is an endoscopic technique for removing large polyps or early cancer / pre-cancerous lesions in the oesophagus, stomach, small bowel or colon. EMR is a technically demanding technique that requires a high level of endoscopic skills to perform and additional training. EMR may offer an alternative to surgical resection for carefully selected patients and has considerably reduced complication profile compared to surgery. Dr Marios Efthymiou has expertise in EMR in the oesophagus, stomach, small bowel and colon.


What preparations are required?

Dependent on the location of the lesion that is to be treated, the preparatory instructions for gastroscopy or colonoscopy will need to be followed. Some medications may need to be discontinued before EMR, including aspirin, clopidogrel or warfarin. Before discontinuing any of these medications you must consult your Doctor.


What happens during EMR?

Your doctor will first discuss the risks of the procedure with you and address any questions you may have. You will then meet your anaesthetist who will discuss all aspects of the anaesthetic. Following this you will be taken to the procedure room. You'll then lie on your side, and a needle will be placed in your hand or arm. This is used to administer the anaesthetic. Once you are completely asleep your doctor will pass the endoscope through your mouth or the anus dependent on the location of the lesion to be treated. Using various instruments and techniques the lesion will be examined carefully and if safe to do so will be resected. The procedure usually takes around 30-90 minutes and you will then be taken to the recovery area.


What happens after EMR?

You will be monitored until the anaesthetic has worn off. Because of the anaesthetic, your judgement and reaction time will be impaired for the rest of the day. You will need someone to drive you home and stay with you. You will be required to have clear fluids for the rest of the day and provided you are well you will be able to start your usual diet the next day. Your Doctor will provide some advice regarding recommencing your usual medications.

What are the possible complications of EMR?

Although complications after EMR are uncommon, it's important to recognise complications and treat them early. The most concerning risk is that of perforation of the gastrointestinal tract and its risk depends on the location of the lesion being treated, the size of the lesion and the specific technique that is used for resection. Bleeding after EMR may be a problem and may lead to admission to hospital, transfusion, a repeat endoscopic procedure or rarely surgery.

Contact your doctor immediately if you have a fever after the test or if you notice trouble swallowing or increasing throat, chest or abdominal pain, or bleeding, including black stools. Bleeding can occur up to two weeks after the procedure.If you have any concerns following your test, you should contact your doctor right away.