Anyone have experience with an endoscopic mucosal resection (EMR)?

Hi - it's really no different from a colonoscopy just done with different instruments.

Endoscopic mucosal resection (EMR)** is a minimally invasive procedure used to remove precancerous lesions or early-stage cancer from the digestive tract. Here's how it works:

1. **Procedure Overview**:
- EMR is performed using an **endoscope**, which is a flexible tube equipped with a light and a tiny camera.
- The endoscope allows the doctor to visualize the inside of the digestive tract.
- An **electrical snare** (a thin wire loop) is fed through the endoscope.
- The snare is positioned around the abnormal tissue (lesion) to be removed.

2. **The Process**:
- The snare tightens around the lesion, effectively cutting it off from the surrounding tissue.
- The doctor then removes the lesion using the snare.
- EMR is particularly useful for lesions in the **esophagus**, **stomach**, or **upper part of the small intestine (duodenum)**.

3. **Indications**:
- EMR is recommended for patients with **GI cancer** or **precancerous lesions**.
- It helps prevent the progression of abnormal tissue to cancer.

4. **Preparation and Recovery**:
- Before the procedure, patients may need to fast and avoid certain medications.
- Recovery is usually quick, with minimal discomfort.

For more detailed information, you can refer to reputable sources like the [Mayo Clinic](https://www.mayoclinic.org/tests-procedures/endoscopic-mucosal-resection/about/pac-20385213), [Johns Hopkins Medicine](https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/endoscopic-mucosal-resection), or [Aurora Health Care](https://www.aurorahealthcare.org/services/gastroenterology-colorectal-surgery/endoscopic-mucosal-resection).¹²³

Source: Conversation with Copilot, 7/28/2024
(1) Endoscopic mucosal resection - Mayo Clinic. https://www.mayoclinic.org/tests-procedures/endoscopic-mucosal-resection/about/pac-20385213.
(2) Endoscopic Mucosal Resection | Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/endoscopic-mucosal-resection.
(3) Endoscopic Mucosal Resection Procedure| Aurora Health Care. https://www.aurorahealthcare.org/services/gastroenterology-colorectal-surgery/endoscopic-mucosal-resection.

I had EMR last August after NET was found in the biopsy of the polyp removed during a colonoscopy in May. The preparation was no different from a regular colonoscopy, but the EMR was done at a large hospital by the same GI doctor.

The difference between an EMR and a colonoscopy is that you really need to go to someone who is a specialist skilled in the procedure.

In 2019 I was limited by insurance. So went to a different GI than I had been going to for a colonoscopy. He panicked and tried to do an EMR on the fly to remove an area about 4 cm long and half the circumference of my colon.

He botched it, had to stop part way through due to bleeding, and I had to spend the night in the hospital to make sure they stopped the bleeding. And then the pathology showed the area was only inflammation and not something that needed to be removed.

In contrast, last year I developed high dysplasia in an area of my colon identified in a colonoscopy. I had an EMR done at Mayo Phoenix by a skilled doctor without a problem. It turned out a small part of the area removed had converted to cancer. So I elected to go with a subsequent colectomy. I could have continued with heightened surveillance, and the colectomy confirmed that they got all of the cancer with the EMR, but I didn't want to take a chance.

Moral of the story: this is not something you want to have done by your garden variety GI, but it can be a very effective procedure.

Thanks for the input! Hardingv, sorry for what you went through in 2019. I'm very compulsive about researching doctors who are going to operate on me. The doctor who will do the EMR seems very experienced, has written dozens of journal articles about the procedure, teaches it and lectures about it and is at a highly rated teaching hospital. I am not good about medical procedures but reading her resume was very reassuring.

Sounds great. I hope you have a successful, uneventful procedure.

I had the EMR yesterday at UCSF Mission Bay. The prep was pretty bad...both Golytely and Sutab over 2 1/2 days, all while on a clear diet. Ugh. The procedure apparently was difficult and challenging to perform according to the doctor's notes. But for me, it was like they put me to sleep for a while and then woke me up but nothing else. No pain or even discomfort. I would like to thank whoever invented this procedure, as well as my doctors. In the past, I would have required major colon surgery with a hospital stay and long recovery. Instead, I feel back to normal the morning after. Waiting for pathology report but the doctor was quite sure the huge polyp was benign at this point and that it's gone.

That's terrific! Fingers crossed on pathology.