Gastroenterology - Endoscopic Mucosal Resection (EMR) in the Upper Gastrointestinal Tract (food pipe/stomach)

What is this leaflet about?

This leaflet is to tell you about a treatment called Endoscopic Mucosal Resection (EMR). It is used to remove early cancer or abnormal cells from the oesophagus (food pipe) or stomach.

We want you to understand what this treatment is, why it is needed, and what the risks are. You will be asked to sign a form to say you agree to have the treatment.

What are abnormal or early cancer cells?

Some people are at higher risk of getting cancer in the food pipe or stomach. This might be because of problems like Barrett’s oesophagus or chronic gastritis.

Doctors might find early cancer or abnormal cells during an endoscopy (a camera test). These cells have not spread, but they might turn into cancer in the future. EMR is a way to remove them early,

What is Barrett’s oesophagus?

This is when acid from the stomach damages the food pipe over time. This can make the lining of the food pipe change and increase the chance of cancer. People with Barrett’s have regular camera checks (endoscopies) to look for any changes.

What is EMR?

EMR is a treatment done during an endoscopy. A doctor uses a thin, bendy camera with a wire loop to cut out the abnormal or early cancer cells. The piece that’s taken out is sent to the lab to be checked.

The aim is to remove the bad cells without needing surgery, chemotherapy, or radiotherapy.

How many treatments will I need?

• You will usually have a follow-up endoscopy in 3 to 6 months
• If you have Barrett’s oesophagus, you may need more treatment called ablation (to remove the rest of the Barrett’s cells) over 3 to 4 sessions every few months

How can I help the treatment work better?

• You may need to take medicine to reduce stomach acid (like omeprazole or lansoprazole) for life
• You might also get other medicines for a few weeks to help you heal (Famotidine and Sucralfate)
• To help your body heal and reduce cancer risk:
  ○    Stop smoking
  ○    Keep alcohol low
  ○    Avoid foods and drinks that cause reflux (like spicy food or fizzy drinks)

Before the EMR treatment

• You’ll have an appointment with a doctor to explain everything and talk about any risks
• Small areas can be treated under sedation (a medicine to make you sleepy)
• Bigger areas may need general anaesthetic (where you’re fully asleep)

If you need general anaesthetic:

• You’ll have a health check with the anaesthetic team
• You may be asked to stay overnight after the procedure

You’ll also be told:

• Not to eat or drink before the treatment
• When to stop taking any blood-thinning medicines
• To bring someone with you and have an adult stay with you for 24 hours after sedation

What happens during the procedure?

Before the procedure:

• You’ll meet the staff and have a drip (small tube) put in your arm
• The doctor will explain the plan and ask you to sign a consent form

If under sedation:

• You’ll get a throat spray and medicine to make you sleepy
• The camera goes down the throat to remove the abnormal area
• The doctor may give more sedation if needed

If under general anaesthetic:

• You’ll be fully asleep
• The doctor will use the camera to remove the abnormal area
• You’ll wake up after it’s done, and the team will talk to you

Is EMR painful?

The camera test doesn’t hurt, but you may feel sore or uncomfortable after the treatment. Most people only need normal painkillers.

After the EMR treatment

• You’ll stay in the hospital for at least 2 hours after the treatment
• Some people may stay overnight
• You’ll get medicine to reduce acid
• You’ll be asked to come back in 3–6 months to check the area has healed

Are there any risks with EMR?

Like any treatment, EMR has some risks:

Common risks of endoscopy:

• Sore throat (can last a few days)
• Bloating or tummy discomfort
• Small risk of damage to the food pipe or stomach
• Bleeding (small chance)

Risks from EMR:

• Pain or discomfort – usually mild but seek help if it’s very bad
• Scarring (stricture) – can make swallowing harder. We can stretch the area if needed
• Perforation (a hole) – rare (1–2 in 100). You may need treatment in hospital
• Bleeding – rare (1–2 in 100). May happen during or after the procedure (up to 2 weeks later). Watch for:
  ○    Vomiting blood
  ○    Black poo
• Sedation problems – rare. Can be reversed with other medicine
• Anaesthetic risks – low but include chest infections, heart or lung problems. These will be discussed with you beforehand

What happens when I go home?

Eating and drinking:

• Don’t eat or drink for 2 hours after the procedure
• Then have clear drinks, followed by soft food for about a week
• If your swallow gets worse after 10–14 days, contact us

Watch out for serious symptoms:

Go to A&E if you:

• Have a fever
• Vomit blood or pass black poo
• Get bad chest pain
• Notice swelling in your neck or chest

Follow-up and results

• Your results may take 3–4 weeks
• You’ll be seen again in 3–6 months for a check-up
• If you have Barrett’s, you may need extra treatment to remove any remaining bad cells

If you have any questions at any time you may contact:

• Kerry Quinn Upper GI clinical nurse specialist on 07873 704349 or
• The secretaries involved in your care – 0161 206 5671