What are EMR and ESD?
EMR stands for Endoscopic Mucosal Resection and ESD for Endoscopic Submucosal Dissection. These are highly specialised, minimally invasive techniques performed by specially trained expert endoscopists used for removal of larger precancerous lesions or early cancers from the gut lining.
ESD is most often performed in the oesophagus, stomach, colon or rectum, and EMR is also commonly performed in the duodenum (first portion of the small bowel).
“Prior to EMR or ESD, treatment of many of these early cancers or precancerous change required surgery. EMR and ESD allow these conditions to be treated as an outpatient…”
~ Dr Keegan
Why are EMR and ESD important options?
Prior to EMR or ESD, treatment of many of these early cancers or precancerous change required surgery — partial or entire surgical removal of gut organs. This surgery carries significant risk of complication or death, and can be associated with lifelong symptoms, changes in function, or need for a stoma (external bag). These surgeries often require long hospital stays.
EMR and ESD allow these conditions to be treated as an outpatient (or sometimes short hospital admission), without external incisions, and while maintaining your normal anatomy.
Why is EMR or ESD performed?
The reasons for considering EMR or ESD may be many, though the most common are:
? focal precancerous changes (dysplasia) in Barrett’s oesophagus
? early oesophageal cancer (or high risk precancerous changes)
? early gastric cancer, or focal precancerous changes
? large polyps and early cancer in the colon or rectum
? EMR may be considered in polyps in the duodenum (first part of the small bowel)
What does the procedure involve?
In some situations, you may have an initial procedure to decide if the lesion is appropriate for these procedures. This involves careful assessment to determine factors including the likely levels of the gut wall involved. The anaesthetist will give you medication through a drip so that you are asleep, this is most often on your left side.
After assessment of the lesion, a viscous blue solution is injected (into the submucosa) elevating the lesion to allow safe and complete removal of the lesion. The aim in ESD is to remove the lesion in one piece, while for removal of larger lesions with EMR, the lesion may be removed in pieces.
How do I prepare?
Before the procedure, you will need to fast for six hours (with the exception of small amounts of water and black tea/coffee without milk or other additives until two hours prior). You may also need to stop taking certain medications, particularly blood thinners and diabetic medications. Your current medications should be provided to the doctor before the procedure. Your doctor may give you personalised instructions on how to prepare for the procedure. For procedures in the lower gut a bowel preparation will be discussed with you.
What are the risks of EMR/ESD?
The risks of the procedure is influenced by the size and location of the lesion and the techniques used. This will be discussed prior to your procedure.
What should I expect during the procedure?
As you will have had sedatives for the procedure driving is not allowed after the procedure. Even if you feel alert, your judgement can be affected so someone should accompany you home and stay with you, and you should avoid making important decisions or operating vehicles or other heavy machinery. Most EMR and ESD cases are performed as an outpatient. There may be reasons for your doctor to advise a short admission for observation.
