Endoscopic Mucosal Resection

Endoscopic Mucosal Resection (EMR) is a minimally invasive procedure used to remove abnormal or precancerous lesions from the lining (mucosa) of the upper gastrointestinal (GI) tract, including the esophagus, stomach, and duodenum. It is a key therapeutic technique for early-stage cancers and large polyps that have not invaded deeper layers of the GI wall.

Indications for EMR in Upper GI Endoscopy

• Precancerous lesions, such as Barrett's esophagus with dysplasia.
• Early-stage cancers, including esophageal, gastric, or duodenal cancers confined to the mucosa.
• Large or sessile polyps, which cannot be removed using standard polypectomy techniques.
• Lesions identified during surveillance in patients with conditions like familial adenomatous polyposis (FAP).

EMR Procedure Steps

Preparation:

• Patients are required to fast for 6–8 hours before the procedure.
• Sedation or general anesthesia is administered for comfort.

Identification:

• The lesion is located and carefully examined with the endoscope. Advanced imaging techniques, such as chromoendoscopy or narrow-band imaging, may enhance lesion visibility.

Injection:

• A saline solution, often mixed with epinephrine or a dye, is injected beneath the lesion. This creates a cushion to lift the lesion away from the deeper layers of the GI wall, reducing the risk of perforation.

Resection:

• A snare or cap device is used to encircle and excise the lifted lesion. Electrocautery may be employed to minimize bleeding.

Post-Procedure Care

• Observation: Patients are monitored for complications, such as bleeding, pain, or perforation.
• Dietary Restrictions: A liquid diet may be recommended initially, followed by a gradual return to solid foods.
• Medications: Proton pump inhibitors (PPIs) may be prescribed to promote healing and reduce acid-related irritation.

Risks and Complications

• Bleeding: Usually managed endoscopically with clips or cautery.
• Perforation: Rare but may require surgical repair.
• Stricture Formation: Particularly in the esophagus, requiring dilation in some cases.

Benefits of EMR

• Minimally invasive: Avoids the need for open surgery in early-stage cancers.
• Preserves organ function: Allows for complete resection without removing significant portions of the GI tract.
• Histopathological Analysis: Provides a complete specimen for accurate diagnosis and staging.