Endoscopic Mucosal Resection (EMR)

Endoscopic mucosal resection (EMR) is done to remove abnormal tissue (a lesion) from your digestive tract. Tissue can be abnormal for different reasons including cancer.

EMR is performed with an endoscope (flexible tube equipped with a light and tiny camera). Your doctor puts this tube down your throat to see inside and remove the abnormal tissue from your esophagus, stomach or upper part of your small intestine (duodenum). If needed, your doctor can get tissue samples (biopsy) during EMR. These samples are examined in a lab to check for problems.

EMR also can be used to remove abnormal tissue from your colon. In that case, the tube is inserted into your anus.

Why it is Done

Endoscopic mucosal resection (EMR) removes abnormal tissue from the digestive tract to check for cancer or precancerous conditions. It also is used to remove tissue that shows signs of early cancer. Sometimes, tissue is abnormal from Barrett's esophagus. EMR allows tissue to be removed without surgery.

What to Expect

  • You may be asked to not eat before your procedure or to eat only clear liquids. You may need to clean out your colon like you would do for a colonoscopy. Your doctor tells you if this is necessary.
  • You also might need to avoid smoking and taking certain medications before EGD. Your doctor goes over these instructions with you.
  • EMR is an outpatient procedure. You are sedated with medication given through a needle in your arm (intravenously or IV). The medication might make you sleepy. If you feel any discomfort, it should be minimal.
  • Your doctor may numb your throat with a spray before placing the endoscope (tube) in your mouth. You lie on your side during the procedure. Sometimes, the endoscope needs to be inserted through the rectum.
  • Your doctor can see inside you as the camera in the endoscope transmits pictures to a computer. Your doctor guides the endoscope to the area of the lesion.
  • Through the endoscope, your doctor injects fluid and suction to lift up the lesion for removal. The lesion is cut and removed with tools inserted through the endoscope.
  • Your doctor marks the place where the lesion was removed with ink so the area can be found easily in future exams.
  • The procedure takes 30 to 60 minutes. You are monitored for an hour or two afterward. This waiting period is normal after sedation medication. Then you can go home.
  • You can't drive yourself home after having sedation medication. Be sure to bring someone along or arrange for a ride home.
  • You might need to rest the remainder of the day because you've had a sedative. Usually, you can return to most normal activities the next day. You might notice a sore throat or abdominal bloating for a day or two.
  • Your doctor might recommend a different diet for the first few days after the procedure to help your throat recover.

Your doctor will talk to you about the results of your EMR, including more treatment and checkups you may need.

If you have Barrett's esophagus, you may need additional treatment after EMR such as cryotherapy, radiofrequency ablation or surgery to remove your esophagus.

What the Risks Are:

EMR is generally a safe procedure when performed by experienced gastroenterologists. Complications are not common. About 20 percent of people who have EMR have chest pain after the procedure.

Some people have a reaction to sedation medication or bleeding. Infection is a possibility with many procedures. Rarely, you can get a tear in your digestive tract that needs surgical repair. Your esophagus also can become narrowed by EMR. This can occur when the area where the lesion was removed develops scar tissue. It can cause swallowing trouble, and you may need treatment for it.

If you have symptoms such as fever, chills, shortness of breath, black or red (blood) stools, vomiting or chest pain, contact your doctor or get immediate medical care. Chest pain can be a sign of a more serious condition. Get emergency medical care if you have chest pain.

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