Mucosal Resection and Submucosal Tumor Resection (Endoscopic Resection)

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are minimally invasive procedures used to remove abnormal or precancerous growths from the lining of the digestive tract.

• EMR is typically used for lesions confined to the superficial mucosal layer, such as large polyps or early-stage cancers.
• ESD allows removal of deeper or larger tumors in the submucosal layer, often in the stomach, esophagus, or colon.

These procedures help avoid open surgery while enabling accurate diagnosis and potentially curative treatment.

• Preparation is similar to a colonoscopy or upper endoscopy: fasting for at least 6–8 hours before the procedure.
• For colon EMR/ESD, a bowel preparation regimen is required.
• Inform your doctor of any medications, especially blood thinners, as these may increase bleeding risk.
• You may need pre-procedure blood work and an anesthesia evaluation.

The procedure is performed under sedation or anesthesia using an endoscope. After identifying the lesion, the doctor injects fluid under it to lift the abnormal tissue, making resection safer.

• In EMR, the lesion is snared and removed, often in sections.
• In ESD, special cutting tools are used to dissect the submucosal layer, enabling en bloc (one-piece) removal of larger tumors.

The procedure may last from 30 minutes to few hours, depending on the lesion size and location.

• Common risks: bleeding during or after the procedure, which can usually be controlled endoscopically.
• Rare but serious risks: perforation of the digestive tract wall, infection, or need for emergency surgery.
• Temporary abdominal pain or discomfort is possible.

Removed tissue is sent for pathology to confirm diagnosis and ensure complete resection. Follow-up depends on findings:

• If benign, routine surveillance endoscopy may be recommended.
• If cancer is detected, further treatment (surgery, chemotherapy, radiation) may be discussed.

Patients are monitored after the procedure and usually resume normal diet and activity within days, though larger resections may require longer recovery.