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Endoscopic Mucosal Resection

Endoscopic mucosal resection (EMR) is a minimally invasive procedure used to remove small lesions in the esophagus that can range from precancerous lesions, such as low-grade or high-grade dysplasia (abnormal cells), to early noninvasive (superficial) cancer. EMR is preceded by an upper endoscopy or endoscopic ultrasound to diagnose and stage the lesions and can assess how deep the tumor has penetrated into the wall of the esophagus. If it is possible to remove the lesions, EMR may be used as a minimally invasive method to remove the entire lesion, instead of performing an esophagectomy, in a selected group of patients. Close endoscopic follow-up is necessary after EMR.

The procedure starts by placing a specialized cap on top of the scope.

Using an injection needle, saline is injected in the submucosa to raise the superficial layers and separate them from the deeper layers of the esophageal wall.

Endoscopic Mucosal Resection1

Then a snare is fitted on the inside of the cap.

Endoscopic Mucosal Resection2

The elevated lesion and the outer layers of the esophagus are suctioned into the fitted cap.

Endoscopic Mucosal Resection3

Then the suctioned layers are cut out by the snare and sent for microscopic evaluation by the pathologist. 

Endoscopic Mucosal Resection4

Documented complete resection provides cure from the lesions. Close endoscopic follow-up is still necessary after EMR.

By Michel Kafrouni, M.D.