Endoscopic mucosal Resection (EMR)
What is endoscopic mucosal resection (EMR)?
Endoscopic mucosal resection (EMR) is an advanced endoscopic technique used for the removal of large polyps in the oesophagus, stomach, duodenum, or colon. This procedure is a less invasive alternative to surgery for removing large polyps and is usually performed by a Gastroenterologist with expertise in interventional endoscopy.
How do I prepare for an EMR?
The preparation for EMR will be determined by whether the procedure is performed via gastroscopy or colonoscopy (see preparation instructions for gastroscopy or colonoscopy). Your Gastroenterologist will provide you with specific preparation instructions.
An empty stomach is essential for a safe procedure, so you should have nothing to eat for six hours beforehand. You can continue to drink ‘clear fluids’ only (i.e. water, clear fruit juice without pulp, cordial, black tea/coffee WITHOUT milk, Gatorade/sports drinks, soft drinks) up until two hours prior to your procedure. After that you must remain nil by mouth apart from a sip of water with any important regular medicines (but do not take any diabetes medications). Patients taking diabetic or blood thinning medications should inform their Gastroenterologist as they may require specific instructions.
How is EMR performed?
Deep sedation is administered by an anaesthetist prior to your procedure so that you are comfortable. EMR technique usually involves injecting fluid under the polyp to lift it away from the muscle layer of the bowel wall followed by removal of the polyp with a snare passed through the scope. The procedure usually takes approximately 60 minutes to complete.
What happens after EMR?
Following the procedure, you will remain in the recovery area for an hour or so until the sedation medication wears off. Your Gastroenterologist will briefly inform you of your test results on the day of the procedure and if necessary, a follow-up appointment may be made to discuss the test results in more detail. Surveillance procedures at 3-6 months and 18 months are usually necessary to ensure there is no polyp recurrence.
Because of the sedation medication given during the procedure, it is very important that you do not drive a car, travel on public transport alone, operate machinery, sign legal documents or drink alcohol within the first 24 hours after the procedure. After 24 hours you can return to work and resume normal activities. It is mandatory that a responsible adult accompanies you home after the procedure and stays with you overnight.
What are the risks or side-effects?
Endoscopic mucosal resection is an advanced endoscopic procedure for the removal of large polyps and therefore the risk of complications is higher than for diagnostic endoscopic procedures. Significant pain (post-polypectomy syndrome) can occur in 1% and usually requires hospital admission. The risk of significant bleeding is approximately 5-6% and can occur up to two weeks following the procedure. Hospital re-admission, blood transfusion and further procedures (i.e. colonoscopy, embolization and rarely surgery) may be required. The risk of perforation is approximately 1%, which if recognized during the procedure may be successfully managed with endoscopic clip closure, otherwise surgery may be required. The risk of splenic injury or aspiration (chest infection) are estimated at 0.1%. Other risks including but not limited to anaesthesia-related complications, cardiopulmonary events and infection are rare. Like all medical procedures, there is a remote chance that a significant complication can result in death following EMR, however this is exceedingly rare.