Overview

If your doctor has found abnormal cells (dyplasia or pre-cancerous cells) in your food pipe (oesophagus), they might recommend you have endoscopic mucosal resection (EMR).

An EMR removes pre-cancerous cells, or small areas of cancer, without the need for major surgery. It removes abnormal cells during a procedure called a gastroscopy.

You have probably had a gastroscopy before, but please ask your medical team if you would like more information about this procedure. 

An EMR takes about 30 minutes. You can leave hospital on the same day and do not need to stay in hospital overnight.

An EMR is a bit like a biopsy, but bigger and slightly deeper to remove the abnormal cells in your oesophagus. Some of the surrounding normal cells might also be removed, to make sure the cell removal is complete.

This procedure is done with sedation, which is given into a vein in your arm (intravenously). This will help you feel relaxed and feel as little discomfort as possible.

Who can have an EMR

Only certain people can be offered an EMR. You might have an EMR if:

• you have a very small area of the oesophagus affected
• your tissue is only showing early changes

Your doctor will discuss what the best treatment is for you. They'll only offer you an EMR if they are confident that the abnormal area or cancer has not spread.

If the tissue removed during an EMR shows that the cell changes are more than were suspected, we'll contact you to talk about other treatment options. 

Risks of an EMR

As will all procedures, there are some risks and your doctor will discuss these with you.

Bleeding

This is often minor, but can occasionally mean you need to go to hospital to control the bleeding. This happens in 1 out of every 200 people who have an EMR

Hole or tear (perforation) in the oesophagus wall

This affects about 1 in every 200 people who have an EMR. 

Chest pain

It's common to feel this for up to a week after an EMR. You can take your usual pain medicine first. If this does not help, we recommend taking co-codamol. 

Scar tissue

This is a risk if a large area of tissue is removed. Scar tissue can narrow your oesophagus, making it difficult and painful to swallow. If this happens, contact your medical team. They'll book you in for another gastroscopy so that the narrowing can be stretched. 

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to have the procedure or treatment, we will ask you to sign a consent form. This says that you understand what is involved and agree to have the treatment.

Read more about our consent process.

Before having an EMR

Do not eat anything for 6 hours before your EMR.

Do not drink anything for 4 hours before your EMR. You can have small sips of water for up to 2 hours before.

Wear loose-fitting clothes on the day of the test.

If you feel that your health has got worse since seeing the doctor or specialist nurse in clinic in the time period before your EMR, please call us for advice. Phone: 020 7188 2673

This procedure is done with sedation. 

Sedation is medicine that makes you feel relaxed and sometimes sleepy, but you'll still be awake. Your endoscopist will explain this to you in more detail.

You need to arrange for a friend or family member (18 years of age or older) to take you home after your procedure. If you do not organise someone to take you home, or if they are under 18 years old, you cannot have sedation and your procedure might be cancelled.

Contact your medical team to make other arrangements if you do not have someone to take you home.

Your usual medicines

Let your medical team know if you take any medicines. This includes anything you buy from a pharmacy or shop, any herbal or homeopathic medicines. You can tell them at your pre-assessment appointment.

Please bring all of your medicines into hospital with you. If you forget to bring them with you, let the team know exactly what you take.

Tell your doctor or nurse if you:

• have any allergies to medicines
• are taking medicines that thin your blood, such as antiplatelet medicines (aspirin or clopidogrel) or anticoagulant medicines (warfarin or rivaroxaban), as you might need to stop them for a short time before your procedure
• have diabetes, you might need to change the dose of your diabetes medicines as you will not be able to eat for a short time before the procedure

More information on stopping any medicines will be given to you when you come for your pre-assessment appointment.

Continue to take your medicines as prescribed unless we ask you to make changes. Do not make any changes to your usual medicines, or stop taking them, unless you have been asked to.

If you have questions about your medicines, please ask a pharmacist or a member of your medical team.

When you arrive at the endoscopy unit

When you arrive, please give your name to the receptionist or nurse. We'll ask you to wait in the waiting area until you are seen by an endoscopy nurse.

The nurse will ask you about your medical history. Please tell the nurse if you have had any reactions or allergies to other examinations in the past.

We ask you to take off all your jewellery before the examination. You might wish to leave any valuable jewellery at home, as we cannot be responsible for any valuables lost while in the unit. All metal needs to be removed, as we use an instrument that uses an electrical current to stop any bleeding.

You might be asked to remove your clothing and change into a gown. You can bring your own dressing gown and slippers with you (we do supply non-slip socks).

Once you're ready, you'll be taken to the second waiting area, signposted ‘sub wait area.’

Your endoscopist will tell you more about the procedure and answer any questions you have.

Delays to your appointment

Our endoscopist teams run up to 5 procedure rooms at the same time. Sometimes another person who arrived after you might be called in before you.

This does not mean you have been forgotten, but that the other person is on a different list to you.

We do everything we can to avoid keeping you waiting any longer than needed. However, because every procedure takes a different length of time to complete, it is hard to give exact timings. We will update you regularly on how long you are likely to be with us.

Please be prepared to be with us for the whole morning or afternoon, depending on whether you have a morning or afternoon appointment. 

We also deal with emergencies in the department. These can take priority over your appointment, meaning we might have to ask you to wait. Please be patient with us, and check at the reception desk if you're concerned.

After an EMR

After the procedure you'll be taken to the recovery area. 

The nurse will check your blood pressure and pulse, and will take you to the discharge area when you are stable.

You'll be offered some tea and biscuits in the discharge waiting area. You can bring your own sandwich or other snacks with you.

A nurse will talk to you about how the procedure went. They'll give you a copy of the EMR report and a copy will also be sent to your GP. 

A family member or friend must escort you home about 1 to 2 hours after the EMR. This person should be 18 years of age or older. We recommend that someone stays with you overnight.

When you leave hospital

You'll need to rest at home and avoid strenuous activity for a few days after your procedure.

As you have had sedation, you must follow our instructions to keep safe.

Diet when you leave hospital

• You should have cool liquids only for 24 hours (no hot drinks).
• Have a soft diet for 2 days, such as smooth soups, yoghurt, porridge and scrambled eggs.
• Do not have foods or drinks that are hot. 
• After 2 days you can try a normal diet, but avoid meat and dry foods (such as toast, biscuits and crackers) for another 2 to 4 days.

Medicines when you leave hospital

We will increase the dose (amount) of your strong acid suppression medicines (Omeprazole, Lansoprazole, Pantoprazole, Rabeprazole or Esomeprazole). You'll need to remain on this dose until we recommend otherwise.

You should take these medicines 2 times a day, at least 30 minutes before you have breakfast and your evening meal.

You might benefit from taking an antacid, such as Maalox or liquid Gaviscon Advance. These can be bought at any pharmacy and some supermarkets. Avoid taking them before or within 30 minutes of your acid suppression medicines.

• Do not take aspirin or non-steroidal anti-inflammatory medicines (such as ibuprofen, nurofen, voltarol, diclofenac or naproxen) for 7 days after your EMR.
• Check with the endoscopist for instructions for taking anti-platelet or anticoagulant medicines before you leave the hospital.
• You can take your usual medicines, but drink plenty of water when swallowing tablets.

If you need care for a digestive issue from any medical team other than the doctors at St Thomas’ Hospital in the next 6 months after your EMR, please contact the endoscopy unit or clinical nurse specialist (CNS) before you start treatment.

Side effects of EMR

It's common to have these side effects for 7 to 10 days after an EMR:

• chest tightness or discomfort
• mild discomfort with eating or food getting stuck, particularly hot or solid foods. It will help if you chew your food thoroughly before swallowing

You can use soluble paracetamol or co-codamol as needed if you are uncomfortable.

You can take anti-sickness medicine if you feel sick or are being sick. These can be purchased from any pharmacy.

If you have any bloating or tummy (abdominal) discomfort, this might be from the air that was put in by the endoscopist during the examination. This is normal, and should settle within 24 hours.

Peppermint tea can help relieve the trapped air.

Your EMR results

The endoscopist or discharge nurse will talk to you about your EMR before you leave hospital. They give you a copy of your report so that you understand the outcome of the procedure, and any next steps.

The sample of the oesophagus lining removed during the procedure is sent to a laboratory for examination. We'll contact you with the results as soon as they are available. This might take 3 or 4 weeks. 

Depending on the results, you might be invited to come back for an endoscopy reassessment and a HALO ablation procedure.

Follow-up appointment

The upper gastrointestinal CNS will contact you between 24 to 48 hours after your procedure to check on your symptoms and recovery.

You can call the CNS on 020 7188 2673. 

You might already have a follow-up outpatient appointment. If not, this will be posted out to you for the next available clinic.