Overview

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

You can have sedation and a painkiller, which will be 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
• you are not suitable to have an operation to remove the cells

Your doctor will work out what the best treatment is for you, and only offer you an EMR if they are confident that the abnormal area or cancer has not spread.

If the abnormal area is large, it can be treated by having another EMR.

If the tissue removed during an EMR shows that the cell changes are more than were suspected, then you might have an operation called an oesophagectomy.

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. 

Please contact the nursing staff as soon as possible if you:

• are taking medicines to thin the blood or to prevent blood from clotting (anticoagulants or antiplatelets, such as warfarin, rivaroxaban or clopidogrel)
• have diabetes and are on insulin
• have allergies to any medicines
• are allergic to latex

You might need special instructions to prepare for your EMR. 

If your health has got worse since seeing the doctor or specialist nurse in clinic before your EMR, please call us for advice: 020 7188 2673

If you are having sedation

This test is usually done with sedation, or an injection of painkillers.

Sedation is medicine that makes you relaxed and sometimes sleepy, but does not put you to sleep. 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 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 yourself over the counter, or any herbal or homeopathic medicines too. 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.

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you agree to have the treatment and you understand what it involves.

If you would like more information about our consent process, please speak to a member of staff caring for you.

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 are ready, you will 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 are a morning or afternoon admission.

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 are concerned.

After an EMR

After the procedure you will be taken to the recovery area. If you have had sedation, you will need to rest quietly for about 1 hour.

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

You will 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 explain your results and give you a copy for your own records. You will be able to leave as soon as the nurse has given this to you.

If you had sedation

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

If 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 or sloppy diet for 2 days, such as smooth soups, yoghurt, porridge and scrambled eggs.
• Do not have foods or drinks that have a high temperature.
• After 2 days you can try 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 prescribe you strong acid suppression medicines (Omeprazole, Lansoprazole, Pantoprazole, Rabeprazole or Esomeprazole) for at least 2 months.

You should take these medicines twice 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, neurofen, 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 take 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 before starting any treatment.

Side effects of EMR

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

• chest tightness or discomfort
• mild discomfort with eating, 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 use an 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 with you 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 is sent to a laboratory for examination. We will get the results up to 2 weeks later, and call you to talk about the findings.

The result determines what happens next.

• You might be invited to have a reassessment and biopsy of the EMR site in 3 months time.
• You might be offered HALO ablation (heat treatment to the EMR site).

Follow-up appointment

The upper gastrointestinal clinical nurse specialist (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.

If it is urgent, you will be given your appointment on the same day.

Risks of an EMR

Your doctor will discuss any risks of an EMR with you. They include:

• 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. You would need to go to hospital if this happens. Sometimes, surgery is needed to repair it
• chest pain. It's common to feel this for up to a week after an EMR. Try using your usual pain medicine first. If this does not help, you can ask for a codeine tablet from a pharmacy
• 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 will book you in for another gastroscopy so that the narrowing can be stretched. You might also have steroid treatment to help stop the scar tissue from forming

Other treatment options

The only other treatment to remove abnormal cells is an operation called an oesophagectomy. This is where part of your oesophagus, including the area of abnormal cells, is removed.

This is a major operation. People who have this treatment usually need to stay in hospital for some time, including in the intensive care unit. Due to the nature of the surgery, it can take months to recover fully.

EMR targets only a small area of tissue compared to an oesophagectomy, which removes a much larger section. 

If the abnormal cells have spread, they are more likely to be removed if you have an oesophagectomy. So for some people, surgery is still a better option.