Endoscopic Mucosal Resection (EMR)

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You have been advised by your hospital doctor to have a procedure known as an EMR. This procedure requires your formal consent. This booklet has been written to enable you to make an informed decision in relation to agreeing to the investigation. You will be required to sign a consent form on the day of the procedure, which is a legal document, therefore please read this booklet carefully beforehand. You need to understand all the information, including the possibility of complications. There will be the opportunity to speak to a health care professional about anything that you do not understand on the day of the procedure before you sign the consent form.

What is an EMR?
An Endoscopic Mucosal Resection (EMR) is a technique which may be used to remove polyps that are larger than average or a more awkward shape than usual. It is carried out via an endoscope.

What is a polyp?
A polyp is a small wart-like growth that sometimes forms on the lining of the bowel. If left to grow, polyps sometimes become cancerous. By removing polyps, the risk of developing bowel cancer is
greatly reduced.

Why do I need to have an EMR?
We have found a polyp in your bowel. Most polyps are easy to remove but, in your case, the polyp is larger than average or is a shape that is more difficult to remove. This requires an EMR. This is
generally considered the simplest and most straightforward method of removing this type of polyp.

Are there any alternatives to an EMR?
There are two other options:
• Do nothing and leave the polyp where it is. However, this is usually not advisable as large polyps often turn cancerous if they are left to grow.
• Remove the polyp by having an operation on the bowel. Although a straightforward procedure, this carries the risks associated with general anaesthetic and surgery (such as infection) and usually leaves you with a scar on the abdomen (tummy). Occasionally this can require a stoma (bag on your abdomen), although this may be only temporary.

You should have been sent an Information leaflet for Colonoscopy/ Flexible sigmoidoscopy with this leaflet. Please refer to these for:
• How do I prepare?
• What about my medication?
• What to bring with you?
• How long will I be in the Endoscopy unit?

What happen when I arrive and during your procedure?
From your point of view, you may not notice any significant difference from your previous colonoscopy. The EMR will be carried out by an expert colonoscopist who has undergone additional training in order to perform this type of procedure safely. It may or may not take longer than your previous procedure, depending on the size, shape, and location of the polyp. It can vary
from five minutes to an hour. Sedation and a pain killer can be given to help you relax. Most patients find EMR comfortable but, if this is not the case, you can tell the colonoscopist and more
sedation or pain killer may be given, or the procedure stopped.

The endoscopist will use the endoscope (camera) to find the previously detected polyp. They will assess whether the EMR is the best way to remove the polyp. If so, it will then be removed using
the endoscopic technique. If a sample (biopsy) has been taken during the procedure, the results may take several weeks. Details of results and any necessary treatment should be discussed with your general practitioner (GP) or the consultant who referred you to have the test.

You will need to rest in the recovery area until the immediate effects of the sedation have worn off. Most people can go home the same day, provided they are accompanied and have a responsible
adult at home with them for the following 24 hours. Sometimes the endoscopist may advise that you stay in the hospital overnight, as a precaution. Please bring an overnight bag with you in case this is recommended. Please note that you should not flight for at least 7 days after your procedure.

When will I know the results?
Before you leave the unit, a nurse or the endoscopist will discuss the findings, any medication, further investigations, and follow-up arrangements that you may need. Due to the sedation
temporarily affecting your memory, you may wish to have your responsible adult with you when you are given this information. In general, you will be sent a further colonoscopy appointment about three months after the EMR, to check the site of the previous polyp – this is usually a quick procedure. Before leaving the unit, you should receive a copy of your consent form and written information on aftercare and follow up.

Being collected after the procedure
If you are having sedation, the person collecting you must come to the unit to collect you. We advise that they park in the multi-storey car park before reporting to the Unit.

Are there any risks?
EMR carries the same risks as a standard colonoscopy. These are explained in the colonoscopy information leaflet. However, because of the technical nature of EMR, the risk of perforation or
bleeding is slightly higher (although still very uncommon). In general, EMR is considered the safest technique for removing this sort of polyp.

The main risks are:
• Perforation – This means tearing a hole in the bowel. For EMR, this occurs in every 100 patients. Occasionally perforations heal with antibiotics and sometimes they can be treated with an endoscope. However, sometimes an emergency operation may be needed. As with any bowel operation, a stoma (bag on your abdomen) is occasionally required, although this will usually be temporary.
• Bleeding – Bleeding may occur once in every 50 or 100 patients (1-2%). Sometimes bleeding occurs during the test, but it can occur up to 14 days after the procedure. If bleeding does occur, it often stops on its own. Very occasionally, however, it requires a blood transfusion or further endoscopies to control the bleeding. Very rarely an emergency operation may be required to stop it.
• Incomplete removal – Sometimes the endoscopist cannot remove the entire polyp for technical reasons. If this happens, a repeat procedure or an operation might be planned at a later date.

What to do if you feel unwell:
If you experience pain that is severe and persistent, or you are passing significant amount of blood or clots; you must then seek urgent advice from the Endoscopy Department between 09:00 and
17:30 (01908 996460). Outside these hours, please call a nurse on Ward 8 (01908 996395) for advice or go to your nearest A&E department.

References for the information contained within this leaflet can be obtained if required from the author.

People are unique and the alternatives, risks and benefits will of course vary from person to person. We hope this leaflet will support the information you have already received from your doctor in enabling you to make an informed decision about your care. If you have any further questions, please ask.