Endoscopic Mucosal Resection (EMR)

What is an Endoscopic Mucosal Resection (EMR)?

An endoscopic mucosal resection (EMR) is a minimally invasive procedure that removes precancerous lesions and early-stage gastrointestinal tumours; it uses a thin, long, and flexible tube called an endoscope that has an electrical snare, video camera, and light at one end.

The video camera and light enable your doctor to have a good view of your gastrointestinal tract, while the electrical snare loops around any lesions or polyps, and essentially removes them while also cauterising the wound.

The endoscope can be used to examine both the upper digestive tract (comprising the mouth, oesophagus, stomach, and small intestine) and the lower digestive tract (comprising the anus, rectum, and large intestine).

If an EMR is required in the upper digestive tract, then the endoscope is passed through the mouth and ends in the upper small intestine or duodenum. If an EMR is required in the lower digestive tract, then the endoscope is passed through the anus, rectum, and ends in the large intestine.

How does an EMR work in Singapore?

An endoscopic mucosal resection can be done for both the upper and lower digestive tract. However, preparation for both is very different.

A sedative will be administered to you before the procedure begins.
Depending on where the growth is, the endoscope is inserted either via the mouth or anus.
Your doctor will guide and observe the images on the monitor and lead the endoscope to the growth.
Once the growth is located, it is isolated from the surrounding tissues by either injecting a saline solution below it or lifting it via suction.

The electrical snare is deployed and looped around the base or part of the growth (depending on its size).
An electrical current is sent through the snare which cuts the growth away and cauterises the wound.
The growth is removed as a whole or bit by bit, depending on the size of it.
The endoscope is carefully and gently guided out of your body.
The samples are sent for biopsy.

How do I prepare for an EMR in Singapore?

If your procedure involves the upper digestive tract, you will have to fast for 6 hours prior to it. If your procedure involves the lower digestive tract, your bowels must be clear before you can start; a laxative drink or enema will be supplied to you, and you can use it either the morning of or the night before your procedure.

Who needs an Endoscopic Mucosal Resection?

This minimally invasive procedure is most effective for patients with:

Polyps
Surface level tumours (no penetration of the deeper layers)
Early-stage colon cancer
Early-stage oesophageal cancer
Barrett’s oesophagus

What can I expect after an EMR in Singapore?

Immediately after the scope, you can expect to feel some mild discomfort and bloating – this is normal. You may feel drowsy for a few hours and might not even remember what happened during the procedure. You will have to wait for an hour or two until the sedative wears off and you might need a relative or friend to accompany you home as you will not be able to drive.

After the test, your doctor will inform you if he/she observed any abnormalities and if samples were taken for a biopsy. If such, your biopsy results should be ready in a few weeks and your doctor will call you with the results. The next step will depend on the results of your gastroscopy and if applicable, your biopsy.

What are the benefits of an EMR?

Minimally invasive
Same-day procedure
Considered a cure for early-stage oesophageal, gastric and colonic cancer

What are the possible complications or risks of an EMR?

There are minimal to no risks or complications involved in an EMR, however, if they do occur, this is what to look out for:

Reaction to the sedative: Some patients may experience problems with their breathing, heart rate, and blood pressure.
Sore throat: This is common for an EMR of the upper digestive tract but should disappear in a few hours or days.
Perforation: A tear in the lining of digestive tract, which can be treated with the scope if detected early
Bleeding: Some bleeding might occur along the walls of your digestive tract where the tumour, lesions, or polyps were removed. This can be treated with the scope

Frequently asked questions

Will I have to stay overnight in the hospital?

No, an endoscopic mucosal resection is a day surgery means you will be allowed to go home on the same day if no complications arise. However, with large lesions you may be asked to stay overnight for monitoring

Is the procedure painful?

No, it is not painful as you will be sedated for the whole procedure. You may feel some mild cramping and bloating after the colonoscopy, but no pain.

What happens if the results of my biopsy are poor?

Your doctor will follow-up with you and guide you on the next steps to take.

How will I know if my bowel is empty and ready for the procedure?

You can tell by the colour of your stools. If they are dark and brown, your bowel is not empty. If they are light and yellow, your bowel is empty and ready for the procedure.

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General

Liver

Oesophagus

Biliary/Pancreas

Stomach/Duodenum

Intestinal