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Endoscopic Mucosal Resection

Date issued:  January 2020

For review:  January 2020

Ref: A-340/MB/Oncology/Endoscopic Mucosal Resection v2

PDF: Endoscopic Mucosal Resection [pdf] 158KB

What is it and why is it done?

Gastrointestinal Endoscopic Mucosal Resection (EMR) is a procedure to remove cancerous or other abnormal tissues (lesions) from the Oesophagus (also known as the food pipe or gullet). It is an alternative to surgery and less invasive.

EMR can also be used to collect tissues (biopsy) for diagnosis and if cancer is present, EMR can help determine if the cancer has invaded tissues beneath the digestive tract.

Endoscopic mucosal resection is usually performed by a specialist in the digestive system (gastroenterologist) who has expertise in this technique.

It is performed with a long, narrow tube equipped with a light, video camera and other instruments. During the EMR, the tube (endoscope) is passed down your throat to reach an abnormality in your oesophagus.

How to Prepare

  • If you have any queries about the procedure or find that you cannot keep this appointment please contact the Endoscopy Office between 0900 and 1700 on 01752 432135 or 432136.  

Before you have endoscopic mucosal resection, you'll be asked to provide the following information:

  • Because the sedation is therefore deeper than standard endoscopy an anaesthetic pre-assessment is carried out which may include ECG, chest X-ray and blood tests. This is usually carried out the week before endoscopy.
  • All prescription medications, particularly diabetes medications and blood-thinning drugs, including aspirin.
  • Any drug allergies you may have.
  • If you are taking Warfarin this will need to be discontinued 5 days before the procedure and the INR (International Normalized Ratio) checked the day before. Additional treatment may be necessary and instruction will be issued by your doctor. If patients are on Clopidogrel, Dabigatran, Rivaroxiban, Apixiban, Warfarin or any other blood thinning agents then these need to be stopped prior to EMR. Low dose aspirin (75mg daily) can be continued if needed.
  • If you are taking Clopidogrel (Plavix) this will need to be discontinued 7 days before the procedure but you can still take aspirin.
  • All medical conditions, including heart disease, lung disease, diabetes and blood-clotting disorders

 

The day of the procedure

  • NIL BY MOUTH Have nothing to eat or drink for 6 hours before your appointment. However you can take your medications as normal with a little water.
  • The Endoscopy Unit is on Level 7, Zone D, Derriford Hospital
  • Bring your appointment letter with you.
  • Please note that the appointment time is for your pre procedure check, not the time of your examination.

 

The length of time you will be here will vary enormously but expect it to be anything from two to four hours or more. Please ask your admitting nurse for further information during your admission check.

You will also sign an informed consent document giving your doctor permission to perform the procedure after the risks and benefits have been explained to you. Before you sign the form, ask your doctor about anything you don't understand about the procedure.

 

During the procedure

During an endoscopic mucosal resection, you can expect the following:

  • Oesophago-gastric EMR is usually performed under a light general anaesthetic with an anaesthetist present who may decide that it is best to support breathing with a tube in the airway during the procedure.
  • You'll be asked to change into a gown before the procedure. During the procedure, you'll lie on your side on a cushioned table.
  • You may have your throat sprayed or be asked to gargle a solution to numb your throat to make insertion of the endoscope more comfortable.
  • You will be sedated during the procedure that causes you to be relaxed and drowsy, you may feel slight movement or pressure during the procedure, but you shouldn't feel pain.
  • Nurses will monitor your heart rate, blood pressure, blood oxygen level and comfort while the doctor performs the procedure.

 

After the procedure

You'll remain in a recovery room until most of the effect of the sedative has worn off. You may be given oxygen until you are fully awake.

You might be given some additional patient information for example: leaflets that explain what to do after the procedure and what problems to look out for. If you have any questions or anxieties, please feel free to ask a member of staff.

Transport: You will likely go home the day of your EMR. However, because of sedation used during the procedure, you'll need to have someone take you home.

Driving: For 24 hours after the procedure, you should not drive, drink alcohol or operate heavy machinery.

You should not take Non-steroidal painkillers (such as Ibuprofen or Diclofenac).

Eating and drinking: After the procedure, you should drink liquids only. These liquids (this does include soup) should not be too hot or too cold, around room temperature is the best.

After 24 hours, we recommend you begin taking soft, sloppy foods and continue with this for the next five days.

Ant-acid medication: You should remain on your acid reducing medication continuously.

Side effects/risks

Relatively mild side effects may occur within 24 hours after the procedure including.

Sore throat: Paracetamol should be sufficient to relieve this discomfort.

Wind or cramps: If air was pumped into your digestive system to make it more accessible, you may have wind, bloating or cramps after the procedure. You can also take simple ‘over the counter’ indigestion remedies.

The following signs or symptoms may indicate a serious complication from endoscopic mucosal resection:

  • Fever.
  • Chills.
  • Vomiting.
  • Black stool.
  • Bright red blood in the stool.
  • Chest or abdominal pain.
  • Shortness of breath.
  • Fainting.

If you experience any of the above: During office hours between 8am-6pm ring the Endoscopy Unit on 01752 432163 and 432164 and 437019 and ask to speak to a Nurse Endoscopist. If you have concerns outside of office hours contact your GP or come to the Emergency Department.

Occasionally EMR may cause narrowing of the oesophagus. Removing a lesion that encircles the oesophagus carries some risk of scarring that narrows the oesophagus, a condition that may lead to difficulty swallowing and require further treatment.

Results

You'll likely have a follow-up appointment with the gastroenterologist to discuss the outcome of your endoscopic mucosal resection. Questions to ask your doctor include:

  • Were you able to remove all abnormal tissues?
  • What were the results of the biopsy? Were any of the tissues cancerous?
  • If the tissues are cancerous, will I need additional treatments?
  • How will you monitor my condition?

 

Support

If the results show you have a cancer diagnosis you can talk through any worries or concerns you may have including treatment options and ongoing support from the cancer specialist nurse in upper gastro intestinal cancers. Jen O’Reilly. Frances Robinson and Marilyn Bolter

 

They will be your key workers through your treatments and recovery.

They’re contact details are: 01752 431528

 

Follow-up /surveillance

Depending on the findings, your doctor will advise you about further examinations or treatment required.

Surveillance will likely include regular visual inspections with the use of an endoscope.

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