Endoscopic Mucosal Resection

Overview

What is endoscopic mucosal resection (EMR)?

Endoscopic mucosal resection (EMR) is a minimally invasive procedure that removes a lesion from the gastrointestinal tract of a patient without removing the actual organ. This allows the patient to maintain his or her quality of life.

The gastrointestinal tract is the passageway through which food travels from the mouth to the anus, and includes your esophagus (the “food tube”), stomach, small bowel and colon.

What are esophageal and gastric cancers?

Esophageal and gastric cancers are conditions in which malignant (cancerous) tumors develop through a series of changes (dysplasia) in the mucous lining of your esophagus or stomach. Treatments include EMR, endoscopic submucosal dissection (ESD), surgery, brachytherapy radiation, chemotherapy, and combination therapy (radiation and chemotherapy).

Procedure Details

How is endoscopic mucosal resection (EMR) used to treat esophageal and gastric cancer?

The EMR procedure is performed with an endoscope—a long, thin, flexible instrument about 1/2 inch in diameter. The endoscope is passed through the patient’s mouth. Through the endoscope, instruments are used to lift the lesion in the lumen (the hollow space) of the gastrointestinal tract, with techniques like injecting fluid underneath the lesion. Afterwards, the lesion is cut out using a snare. The doctor will remove the tumor through the endoscope and out the mouth. EMR has a positive outcome for lesions 2 cm in size or less.

How is the endoscopic mucosal resection (EMR) procedure performed?

The EMR procedure for esophageal or gastric cancer includes the following.

  • The patient is given general anesthesia and sleeps during the procedure.
  • The endoscope is passed through the patient’s mouth.
  • The precancerous or cancerous lesion is identified.
  • The surgeon either injects a liquid into the submucosal layer beneath the lesion or places a rubber band underneath the lesion to lift it and make it easier—and safer—to remove. Use of a rubber band is the most common way to lift a lesion. (The submucosa is the layer of tissue just below the mucous membrane.)
  • The surgeon then captures the lesion with the snare device and cuts the lesion out. The lesion is then grabbed and pulled out of the patient’s mouth with the endoscope.

Risks / Benefits

What are the advantages of endoscopic mucosal resection (EMR) for esophageal and gastric cancer?

The advantages of EMR for the treatment of esophageal and gastric cancer include the following:

  • The organ itself (esophagus, stomach) is left in place, allowing a patient to maintain his or her quality of life.
  • EMR is considered a cure for early small esophageal and gastric cancer, as long as the cancer has not spread through the lymph nodes to other parts of the body. Larger lesions may require other more advanced procedures like endoscopic submucosal dissection.
  • Patients who have successful EMR for esophageal and gastric cancer have a low recurrence (return) rate (the cancer rarely comes back).

What are the side effects of endoscopic mucosal resection (EMR) for esophageal and gastric cancer?

The side effects of EMR include bleeding, perforation (tearing) of the esophagus or stomach and stricture (narrowing) of the esophagus or stomach.

Recovery and Outlook

What is the prognosis (outlook) for patients who have an endoscopic mucosal resection (EMR) procedure for esophageal and gastric cancer?

If the cancer is found and treated while it is in an early stage, the prognosis for patients is very good.

Last reviewed by a Cleveland Clinic medical professional on 08/18/2019.

References

  • Klein A, Bourke MJ. How to Perform High-Quality Endoscopic Mucosal Resection During Colonoscopy. (https://www.sciencedirect.com/science/article/pii/S0016508516355573?via%3Dihub) Gastroenterology 2017;152:466–471. Accessed 8/29/2019.
  • American Society for Gastrointestinal Endoscopy. Endoscopic mucosal resection. (https://www.giejournal.org/article/S0016-5107(15%2902405-0/pdf) Accessed 8/29/2019.
  • Shah PM, Gerdes H. Endoscopic options for early stage esophageal cancer. J Gastrointest Oncol. 2015 Feb;6(1):20-30. doi: 10.3978/j.issn.2078-6891.2014.096.
  • National Cancer Institute. Esophageal Cancer Treatment (PDQ®)–Patient Version. (https://www.cancer.gov/types/esophageal/patient/esophageal-treatment-pdq) Accessed 8/29/2019.

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