Endoscopic Mucosal Resection Procedure

Please note, this page is printable by selecting the normal print options on your computer.

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.

If you are unable to keep your appointment, please notify the endoscopy unit as soon as possible. This will enable staff to give your appointment to someone else and to re-arrange another date and time for you.

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 most effective 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?
Sedation options

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 or Flexible sigmoidoscopy. 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.

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. 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.

Aftercare

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 Flexible sigmoidoscopy/ colonoscopy appointment about three to six 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, you must arrange for a responsible adult to collect you and stay with you overnight. If you have not been able to make these arrangements, you will not be able to have the procedure with sedation.

You should not drive, return to work, operate machinery, or drink alcohol for 24 hours after the procedure, nor should you make any important decisions. The reason for this is that the sedation may, even though you may feel perfectly normal, still be in the body and may impair your judgement.

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 large or flat polyps.

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 rest. However, an emergency operation may be needed to repair it but this is very rare. 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 later date.

What to do if you feel unwell once at home

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 996 460) Monday to Saturday.

Outside these hours, please call a nurse on Ward 22 (01908 996 455) for advice or go to your nearest A&E department.