What Is Endoscopic Mucosal Resection?
The EMR procedure, or Endoscopic Mucosal Resection, is a minimally invasive procedure that aims to remove potentially malignant lesions from the GI (gastrointestinal tract) without removing any actual organ in the tract. This allows the patient to maintain their quality of life following the procedure.
In this article, Dr. Omar Rashid and his expert team of medical professionals discuss the details of the EMR procedure, talk about recovery time, and assess all the benefits and possible risks of this colon cancer treatment.
About the GI Tract, Esophageal, and Gastric Malignancies
Before we get more in detail about the EMR procedure, we should first talk a bit more about the GI tract. The gastrointestinal tract is the passageway through which food moves throughout the body, from the mouth to the anus. The tract includes the esophagus, the stomach, the small bowel, and the colon.
Gastric and esophageal cancers are disorders in which cancerous masses develop via a series of uncontrolled mutations in the mucous lining of the stomach or esophagus. Endoscopic mucosal resection may successfully eradicate the malignant cells in early-stage colon cancers and other GI tract malignancies. It may be combined with other treatment options, such as chemotherapy and radiotherapy.
About the EMR Procedure
As mentioned above, the procedure involves inserting a thin medical instrument with a camera and a light into the GI tract first to locate, then remove the cancerous lesions. The medical device is the endoscope, a hollowed tube through which experts insert different surgical tools to remove the tumor. The tube is either inserted via the mouth or the throat to treat esophageal, upper intestine, stomach, or early-stage colon cancers. In the latter case, the endoscope is usually anally inserted.
Naturally, endoscopic mucosal resection will be recommended after establishing a proper cancer diagnosis. Adequate diagnosis is key because if the disease is caught early, an EMR procedure might be enough to treat and eliminate cancer without more aggressive surgery or other treatment methods.
When Patients May Need Endoscopic Mucosal Resection
Typically, the EMR procedure is the best treatment option for several early-stage cancers or precancerous growths in the GI tract.
More specifically, endoscopic mucosal resection is the best option for precancers and cancers that are contained within the GI tract’s innermost lining, i.e., the mucosa. Various digestive malignancies are known to develop in this layer, but if gone undetected, they can spread into deeper layers as time passes. They can spread to other organs as well.
The EMR procedure is used to remove these mucosal tumors as extracting larger tumors would be difficult or impossible with the thin endoscope.
Fortunately, there are also cases when EMR can be efficient cancer treatment even if the tumor has spread to the submucosa, the layer directly beneath the mucosa. More precisely, this procedure is called the ESD or endoscopic submucosal dissection, which involves an identical process, the difference being in the tools, which reach deeper into the lining of the GI tract and remove more tissue from them.
Procedure Details
As mentioned above, the intervention is performed with an endoscope, which is a long, thin, and flexible medical instrument. Depending on the location of the malignancy, the endoscope is passed through the throat, mouth, or anus. Via the thin tube, medical experts insert the necessary instruments to lift the lesion and insert fluid underneath it. After this, doctors cut the tumor out with the help of a snare. The tumor will be removed via the endoscope.
For the most part, EMR procedures are successful in the case of lesions that are 2 cm in size or preferably smaller.
Naturally, the patient is given anesthesia and will sleep during the procedure.
Preparing for Endoscopic Mucosal Resection
If you are a candidate for EMR, your healthcare provider will discuss all the necessary steps you will need to take to prepare for the intervention.
You will probably have a consultation with your doctor about your allergies, medications, and supplements you take, and you will talk about your medical history as well.
If you are taking something that could increase the risk of complications, the doctor recommends stopping the compound or decreasing the dosage.
You may also be recommended to adjust your fluid intake or diet prior to surgery. Patients are usually advised to avoid fluids or food eight hours before surgery. To ensure that your GI tract and bowels are clear before the intervention, your doctor will give you specific instructions if needed.
What to Expect?
An EMR procedure is either performed in an outpatient center or a hospital and will take no longer than a bit over an hour (sometimes, it may take as little as 30 minutes). Still, the entire appointment can last up to even five hours, meaning that patients will have to stay for an hour or two after surgery.
Endoscopic Mucosal Resection Recovery
Following the intervention, your dedicated care team will closely monitor your condition while the anesthesia subsides. Once you’re free to go home, your provider will instruct you on aftercare practices regarding diet and which symptoms to monitor. After the procedure, you will also be instructed to rest and take it easy for a while.
If the endoscope were inserted via the esophagus, you would probably be recommended to follow a liquid-only diet for the first few days of the endoscopic mucosal resection recovery process. Later, you will be allowed to switch to soft and pureed foods like applesauce, yogurt, and smoothies.
Benefits and Possible Risks
The most significant advantages of endoscopic mucosal resection are the following:
- The affected organ where the malignancy started to develop will be left in place, meaning the patient’s quality of life won’t diminish after the intervention.
- Patients who underwent a successful EMR procedure for gastric and esophageal cancer usually have a very low recurrence rate, meaning that cancer rarely returns after the intervention.
- Typically, endoscopic mucosal resection is considered a cure for early-stage and tiny cancers of the GI tract as long as the malignancy is small and in the mucosal lining of the organs. Once the lesions become larger or the mutated cells have traveled to the lymph nodes, experts usually recommend more complex procedures and combined treatment methods.
Potential Side Effects
Unfortunately, like all other types of surgery, the EMR procedure may also have some unwanted side effects. Tearing of the stomach and esophagus, bleeding, and narrowing of the organs may occur in rare cases.
A Promising Procedure With Great Potential
As mentioned above, early-stage cancers can be successfully treated with this procedure, with the prognosis for the patient being fairly good.
The potential benefits will vary from patient to patient, depending on individual circumstances, but the research so far indicates that the EMR procedure has positive outcomes.
If you want to learn more about the benefits and possible risks of Endoscopic mucosal resection, feel free to reach out to our practice today.