Endoscopic mucosal resection

Overview: 

Endoscopic Mucosal Resection (EMR) is a minimally invasive procedure utilized in gastroenterology to remove abnormal or precancerous tissue from the digestive tract lining. The digestive tract consists of multiple organs through which the food passes and digestion occurs. The procedure enables the doctor to reach the digestive tract from outside the stomach, causing less pain and quicker recovery than open surgery. The technique involves inserting a flexible thin tube with a camera called the endoscope in the section of the digestive tract where surgery is required through the anus or the mouth. The individual is sedated, and tools are utilised to take out the irregular tissue. 

Conditions treated by Endoscopic Mucosal Resection:

The procedure is primarily used to treat the early stages of cancer or any abnormal growth in the mucosa tissue, which is the inner lining of the gastrointestinal tract. 

The conditions include: 

• Barrett’s oesophagus, which may lead to precancerous lesions. 
• Colorectal cancer. 
• Cancer of the esophagus. 
• Small intestine/ duodenal cancer. 
• Stomach cancer. 

Who Needs Endoscopic Mucosal Resection: 

People with small tumors and lesions require endoscopic mucosal resection. 

However, people with large tumors need other treatments like: 

• Chemotherapy. 
• Endoscopic submucosal dissection for tumors that are embedded deeply in the wall of the gastrointestinal tract. 
• Radiation therapy. 
• Surgery. 

What Happens in Endoscopic Mucosal Resection?

Preparing before the procedure 

Suppose the procedure is being conducted in the upper digestive tract, which includes the stomach, esophagus, and small intestine. In that case, the person is asked to avoid eating or consuming any drinks and smoking or chewing gum for a few hours before the procedure. 

Suppose the surgery is conducted in the lower section of the digestive tract, which includes the colon and the rectum; a bowel preparation is required, which includes taking laxatives. This cleans the colon and gives the surgeon a better view of the tract. 

People are required to sign a consent form before the doctor performs the surgery for permission. By signing the form, the person agrees to the risks and chances of complications involved in the surgery and takes the entire responsibility for the procedure. Hence, before signing, the person is encouraged to ask the doctor any questions or inquiries and obtain complete clarity on the surgery. 

During the procedure 

The patient is administered anesthesia to avoid discomfort, and the doctor puts the endoscope either through the mouth (for upper tract procedure) or the anus (for working on the lower tract). They detect abnormal tissue and lead the endoscope in that area. The next step is inserting the surgical instruments through the endoscope to remove the tissue, either through suctioning or removing it with the help of an electrical wire. This process takes around half an hour to one hour. 

After the procedure 

A sample is taken from the extracted tissue and sent to the laboratory for testing by the pathologist, who will analyze the sample for any existing diseases. The patient is shifted to the recovery room till the anesthesia wears off. They may require someone to accompany them or drive them home as they may feel drowsy. Some people may experience a sore throat if the endoscope is inserted through the mouth into the esophagus or develop gas, bloating, or cramps if air is pumped into the digestive tract to make the area more accessible. 

Majority of people can commence work the next day post the procedure and may be advised to follow a liquid diet for the next few days to allow their digestive tract to recover completely. It is essential to follow up with the doctor after the surgery to ensure that all the irregular tissue has been removed. The doctor inserts an endoscope into the digestive tract, and depending on the check-up, the doctor decides if any changes in the treatment or additional surgery are required. 

The doctor must be contacted if the person experiences the following symptoms: 

· Blood in your stool. 

· Chest pain. 

· Dizziness/light-headedness or fainting 

· Fever accompanied by chills. 

· Breathlessness. 

Risks and side-effects of Endoscopic Mucosal Resection: 

The side effects of the procedure depend on the section that was treated and include: 

· Bloating. 

· Cramping. 

· Excessive gas or pain in the abdomen 

· Nausea or vomiting. 

· Sore throat. 

The Risks of Endoscopic Mucosal Resection include: 

• Bleeding: This is a common occurrence and can be addressed during the procedure. 
• Esophagus becomes narrow: When a lesion is removed from the esophagus, there are chances of scarring, which leads to the narrowing of the esophagus. This may cause difficulty in eating and swallowing and needs further medical intervention. 
• Puncture (perforation): When the irregularity is removed from the digestive tract, there is a risk of damaging and creating holes in the lining of the digestive tract in the place where the lesion was removed; the size of the hole depends on the size of the lesion that was removed. There are some chances of the wall of the digestive tract being puntured depending on what is the size and location of the lesion that's removed. 

The benefits of endoscopic mucosal resection: 

• The procedure helps remove cancerous tissue before it grows and spreads to other parts of the body without making significant cuts in the digestive tract. 
• The procedure facilitates quicker recovery. 
• It causes less pain and discomfort. 
• The chances of complications are lesser. 
• There is no scarring in the area that is operated. 

In a nutshell, cancer, the word itself, can send chills down the spine and push people into a panic mode. However, with non-invasive surgical interventions such as endoscopic mucosal resection, it gets more straightforward and simpler to remove the abnormal tissue with cancer-like lesions prior to they spread and harm other body parts. 

During the procedure, the doctor doesn't even need to make a cut as compared to other open surgeries, making the recovery faster and pain-free. However, it must be noted that if the tumors are significant, then other alternatives like chemotherapy or radiation should be explored.

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