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Interventional Endoscopic Procedures

ENDOSCOPIC MUCOSAL RESECTION (EMR)

What is an Endocscopic Mucosal Resection (EMR)?

EMR is a minimally invasive, endoscopic removal of benign and early malignant lesions in the gastrointestinal (GI) tract.

About the Procedure

This procedure is performed with a long, narrow tube equipped with a light, video camera and other instruments. During endoscopic mucosal resection of the upper digestive tract, the tube is passed down your throat to reach an abnormality in your oesophagus, stomach or upper part of the small intestine. When EMR is used to remove lesions from the colon, the tube is guided up through the anus.

Upper Gastrointestinal Tract- EMR is used for patients with discrete nodules in an area of Barrett's lining or other areas of the oesophagus. This is a safe and effective way to remove precancerous and early cancerous lesions. When EMR is performed in the oesophagus, you will continue to use anti-acid medication following your procedure to facilitate healing. EMR is used in the stomach to remove early gastric cancers and precancerous lesions. The technique is used in the duodenum to resect duodenal polyps and polyps of the ampulla (bile duct opening).

Colon- EMR is used to resect rectal and colon polyps and early colon cancers.

Preparation

Please do not eat or drink anything 8 hours prior to the procedure time. If the EMR is done in the colon, you will be required to take bowel preparation to cleanse the colon.

During the Procedure

You will be given a sedative by the anaesthetist who will be present to monitor your vital signs during the examination. A mouthpiece will be placed between your teeth to protect your mouth. You will lie on your left side, and the endoscope will be passed through your mouth and into the esophagus, stomach and duodenum. The endoscope does not interfere with your breathing. During the procedure, fluid is injected under the lesion to minimize possible complications. The lesion is then removed with a wire loop and diathermy and sent for histological examination.

For colonic EMR, a colonoscopy is performed under sedation and the lesion is removed with a wire loop and diathermy following injection of fluid under the lesion. The lesion is then removed with a wire loop and diathermy and sent for histological examination.

If necessary, endoscopically placed metal clips are used to reduce the risk of bleeding or perforation.

After the Procedure

After the procedure, you will remain in a recovery room until most of the effect of the sedative has worn off. You will need to make plans to have someone take you home and supervise you for 12 hours afterwards.

Possible Adverse Events

  • Reactions to the anaesthetic, including nausea and vomiting
  • Sore throat, gas or cramps
  • Bleeding
  • Perforation (or tear)
  • Stricture (narrowing of intestine).

ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD)

What is an Endoscopic Submucosal Dissection (ESD)?

ESD is an advanced endoscopic procedure used to remove gastrointestinal tumours that have not penetrated the deeper layers of the gut wall. ESD may be done in the oesophagus, stomach, duodenum or colon.

About the Procedure

Under sedation, a long narrow tube is passed through the throat to reach the lesion in the stomach, or the tube is passed through the anus to reach the lesion in the colon.

The procedure consists of three steps:

  • Injecting fluid into the fat layer under the lesion to elevate it
  • Cutting the surrounding lining of the lesion
  • Dissecting the fat layer beneath the lesion to remove the lesion in one piece.

Preparation

You may not eat or drink anything 8 hours prior to the procedure. If ESD is performed in the colon, you will be required to take bowel preparation to cleanse the colon.

During the Procedure

You will be given a sedative by the anaesthetist who will be present to monitor your vital signs during the examination. A mouthpiece will be placed between your teeth to protect your mouth. You will lie on your left side, and the endoscope will be passed through your mouth and into the esophagus, stomach and duodenum. The endoscope does not interfere with your breathing.

For colonic ESD, a colonoscopy is performed under sedation and the lesion is removed as described above. If necessary, endoscopically placed metal clips are used to reduce the risk of bleeding or perforation.

After the Procedure

After the procedure, you will be admitted to the hospital and monitored overnight.

Possible Adverse Events

  • Reactions to the anaesthetic, including nausea and vomiting
  • Sore throat
  • Gas or cramps
  • Bleeding
  • Infection
  • Perforation (or tear)
  • Stricture (narrowing of intestine).


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