Polyp Removal with EMR and ESD

Sometimes, doctors find polyps, or abnormal growths, in the GI tract that requires the expertise of an Interventional Endoscopist for removal, to prevent cancer.

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) offer two minimally invasive techniques to remove large, flat polyps or lesions — with a much faster recovery than traditional surgery.

Learn how we perform EMR and ESD at our Advent Health Center for Interventional Endoscopy (CIE) and what you can expect.

EMR Endoscopy Procedure

With an EMR procedure, your doctor (endoscopist) uses an endoscope to remove the polyp. An endoscope is a thin, flexible tube with a camera.

First, we pass the endoscope through the mouth or anus to get to the area of interest. Then, we:

1. Inject a solution beneath the polyp.
2. Wait for a cushion to form under the polyp.
3. Place a looped device called a snare around the polyp.
4. Remove the polyp safely. (Figure 1)

ESD Endoscopy Procedure

The ESD procedure is a more advanced endoscopic technique for complex polyp resection.

Like with EMR, your doctor inserts the endoscope through the mouth or anus. Then, we:

1. Mark the borders of the polyp.
2. Inject a solution into the deeper tissue layer to elevate the polyp.
3. Start the dissection with a wide margin using an electrosurgical knife.
4. Dissect underneath the polyp into a deeper layer.
5. Continue dissection until the polyp is removed.
6. Send the polyp to the pathology lab for testing. (Figure 2)

Planning for Your Endoscopy Procedure

You may have an EMR or ESD procedure in the upper gastrointestinal (GI) tract or lower GI tract. The location of your procedure affects how you prepare. Either way, it’s important to follow all instructions before your procedure. You should also tell your doctor about any medications you take, so they can adjust your dose or make appropriate recommendations.

For procedures in the upper GI tract, you can’t eat or drink (with few exceptions) for about eight hours before the procedure. Your doctor will confirm when to begin fasting.

For procedures in the lower GI tract, you will consume a large volume of special cleansing solution or take laxatives or enemas and follow a clear liquid diet.

With both EMR and ESD, you receive intravenous (IV) sedatives to fall asleep. Your team also may use a local anesthetic spray in your throat if they insert the endoscope through your mouth.

What to Expect After EMR and EMD

Because with EMR and EMD you receive sedation, we monitor you after your procedure in the recovery area until most of the medication’s effects wear off. Unless you’re admitted to the hospital, which is rare, you’ll need to arrange for a ride home. You won’t be able to drive immediately after the procedure — even if you don’t feel tired.

If you have an upper EMR or ESD, your throat might be a little sore. You also might feel bloated.

You may also remain on a liquid diet after the procedure. Usually, you can go back to a normal diet the following day, unless you receive other instructions from your care team.

Your doctor will share results from your exam on the same day as your procedure, however, biopsy results from the lab can take a few days. Depending on the results, you may need a follow-up appointment.

Here for All Your Endoscopy Needs

At AdventHealth Center for Interventional Endoscopy at Tampa, we combine endoscopy with minimally invasive surgery to diagnose and treat a wide range of complex GI diseases. Our skilled, advanced endoscopists get you personalized care to meet your specific needs.

To schedule an appointment with the AdventHealth Center for Interventional Endoscopy at Tampa, call Call813-615-7028.