Endoscopic mucosal resection (EMR) is a specialized endoscopic technique used by gastroenterologists like Dr Pavey to diagnose and remove large areas of early cancers or pre-cancerous areas arising in the gastrointestinal tract, including the esophagus, stomach, small intestine and colon.
EMR has become an important and safe alternative to surgery for the treatment of conditions including Barrett’s esophagus, gastric polyps and colon polyps.
EMR gives specialists like Dr Pavey access to areas of diseased tissue about the size of a five-cent piece—four or five times larger than a typical biopsy. EMR may be recommended for patients with suspected high-grade dysplasia, or early cancer, because it allows the gastroenterologist to not only accurately diagnose the stage of growth but also to provide complete therapy by removing the diseased tissue.
Dr Pavey typically performs EMR on an outpatient basis. During EMR, the patient is sedated and a thin, flexible tube (endoscope) is inserted through the mouth and into the esophagus, the pathway that connects the mouth to the stomach. The tip of the flexible endoscope has a lens and a light source, which allow images to be sent to a monitor for close inspection of the lining of the upper gastrointestinal tract.
Using an instrument attached to the tip of the endoscope, Dr Pavey can suction small nodules or growths and trap them in a small, rubber band. This tissue is then removed using an instrument that cuts the tissue. This technique can be repeated in nearby areas, as necessary, to ensure all abnormal tissue is removed. The tissue that Dr Pavey has removed is then carefully evaluated by a pathologist.
Patients with high-grade dysplasia or intramucosal carcinoma (the earliest stage of esophageal cancer) often undergo an endoscopic ultrasound exam before undergoing the resection to ensure there is no deeper tissue involvement.
The procedure typically takes 25 to 35 minutes but can extend to 60 to 90 minutes depending on the complexity of the case.
The patient will be asked not to eat or drink anything after midnight the night before the procedure. If the patient takes daily medication in the form of a pill, he/she may take it with sips of water the morning of the EMR.
Patients must be off blood thinner medications to safely perform EMR. Please confirm all your medications with your treating physician so these can be managed appropriately prior to procedure.
Patients are discharged from the endoscopy unit and may be provided with prescriptions for oral pain medications and an oral numbing solution they may use for five to seven days.
A modified diet is recommended for the first three days after the procedure to allow time for healing. Patients may return to work the day after the procedure.
Dr Pavey has been treating Barrett’s Esophagus since 2004, has been performing EMR also since 2004 and has successfully treated several hundred patients.
Patients who are treated for Barrett’s esophagus with EMR return for a follow-up endoscopy in two to three months to ensure they are healing properly. In most cases, additional treatment in the form of radiofrequency ablation (RFA) is performed at this time to eradicate the remaining Barrett’s tissue.
All patients with Barrett’s esophagus are treated with high dose antacids (typically in the proton pump inhibitor family) indefinitely. A low-acid environment helps the body replace the removed tissue with normal tissue (squamous mucosa). Patients will remain in a surveillance program indefinitely to ensure that the Barrett’s mucosa, or diseased tissue, does not recur.
EMR is a safe and well-tolerated procedure. However, about 20% of patients may have chest pain following the procedure.
About 5% of patients may develop narrowing of the esophagus (known as a stricture) as a result of EMR and may require one or more procedures to stretch the esophagus (known as dilations) to treat this.
Major complications are uncommon (occur in less than 1% of patients), but may include bleeding or perforation of the esophagus.
Dr Pavey performs EMR privately at Lifehouse/RPA, Macquarie University Hospital, and St George Private Hospital.