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Endoscopic Mucosal Resection (EMR)
EMR is a specialized endoscopic technique to remove large areas of precancerous and early cancers arising in the gastrointestinal tract. EMR can be done during upper endoscopy (EGD) or colonoscopy. In the past, patients with such large lesions required open surgical resection of the affected area. In the recent years, this practice has been replaced by EMR due to lower complication rates associated with EMR and the minimally invasive nature of the procedure. Sometimes EUS is needed before EMR to evaluate the depth invasion before EMR. 

Common indications of EMR are: 
  • Resection of large colorectal polyps 
  • Resection of Barretts esophagus (precancerous transformation of the esophageal lining due to long standing reflux) and early esophageal cancers 
  • Resection of precancerous and early cancers lesions of the stomach and small bowel 
EMR is an outpatient procedure. Mild self-limited abdominal discomfort is the most common adverse complication. Most of the large colon polyps and precancerous and early cancers of the GI tract can be safely removed with EMR, saving patients from undergoing surgery. Perforation (complete tear of the GI tract wall) is the most fearful complication of this procedure. Depending on the size and location of the lesion, the chance of perforation is generally considered low (less than 10%) and usually repairs can be done with endoscopic techniques without the need for surgery. In rare instances, surgical intervention is needed to repair the perforation. Although the likelihood of need for emergency surgery is extremely low, EMR is usually done at a hospital with an available backup surgical team, if needed. 

Bleeding is another rare complication associated with EMR. Post-EMR bleeding is usually self-limited. Occasionally delayed bleeding (up to a few weeks after the procedure) can occur. Repeat endoscopic procedure to stop the bleeding is sometimes needed. There are prophylactic maneuvers that the endoscopist can undertake to reduce the chance of post-EMR bleeding. 

The procedure is generally scheduled for one hour and is always done under sedation. Patients are discharged home within an hour after the procedure. The resected specimen is always sent to the pathology for evaluation for presence of cancer cells and to insure complete resection. The pathology results are generally available within one week after the procedure and will be send to the referring physician office to share with you. Patients generally can return to normal daily activities the day after the procedure.