Endoscopic Mucosal Resection

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Endoscopic mucosal resection is a technique performed to remove precancerous, cancerous or other abnormal lesions from the lining of the gastrointestinal tract.

It’s performed while you are under sedation, and you’ll likely go home the same day as your procedure. Endoscopic mucosal resection is a less invasive alternative to surgical removal of diseased tissue. It allows doctors to determine the depth of cancer in tissues beneath the lining of the gastrointestinal tract.

Endoscopic mucosal resection requires skill and experience. Board-certified and fellowship-trained gastroenterologists at Norton Healthcare Gastroenterology have been performing the procedure in Louisville and Southern Indiana for years. Working closely with Norton Cancer Institute, our gastroenterologists make sure you benefit from the viewpoints of multiple specialists.

What Is an Endoscopic Mucosal Resection

Endoscopic mucosal resection can be performed to remove lesions in both the upper and lower gastrointestinal tract via an upper endoscopy or a colonoscopy. For the esophagus, stomach and duodenum, an endoscope — a thin, flexible tube with a camera at the tip — is inserted through your esophagus.

A colonoscopy, also performed under sedation, also uses an endoscope and allows the doctor to see the inside of the colon.

Both techniques provide live images to a video monitor, so your gastroenterologist can remove lesions with precision and care.

There are several techniques used to remove a lesion, depending on its type, size and location. One technique uses a special needle passed through the endoscope and inserted at the base of the lesion. Fluid, along with a blue-colored dye, is injected under the lesion to lift it up from the muscle layer of the bowel. Then, the lesion can be removed without cutting muscle.

In another technique, the endoscope may be equipped with a device that allows the lesion to be suctioned into a cap attached to the tip of the scope. A specially placed rubber band is used to hold the lesion away from the muscle layer during removal.

In both methods, the lesion is removed with a mildly electrified wire loop that cuts it and cauterizes the blood vessels. The lesion tissue is saved for laboratory analysis.

How to Prepare for an Endoscopic Mucosal Resection

Your physician will provide you with instructions you will need to follow in the days before your procedure. Following these instructions is essential to limit surgery risks and provide the best results.

Make sure your providers are aware of all medications that you are taking, especially the following:

  • Plavix (clopidogrel)
  • Effient (prasugrel)
  • Brilinta (ticagrelor)
  • Ticlid (ticlopidine)
  • Coumadin (warfarin)
  • Eliquis (apixaban)
  • Aggrenox (aspirin/dipyridamole)
  • Pradaxa (dabigatran)
  • Persantine (dipyridamole)
  • Xarelto (rivaroxaban)

We will advise you to discontinue or adjust your dosage of these medications. We may have you consult with your primary care physician or cardiologist prior to your procedure. Also let us know of any allergies to medications.

If you are using insulin, the dosage or timing will also need to be adjusted the day of the procedure.

Do not eat anything after midnight before your procedure is scheduled.

For endoscopic resection by colonoscopy, your cleansing routine or prep will start the day before your procedure. A laxative will prepare your bowels and is the most important part of your preparation. Following the instructions and having a good cleanse can decrease the need for a repeat colonoscopy.

After Your Endoscopic Mucosal Resection

After you’ve recovered from the sedation, your physician will give you a preliminary report on the findings. Final test results on the lesions may take several days.

Because of the sedation during the procedure, patients cannot drive, operate machinery or make important decisions for 24 hours following.

You will be able to eat afterward, unless instructed otherwise. Start with clear liquids, building yourself up to bland foods. The nursing staff will review these and other important postoperative instructions with you before you leave the hospital.

Contact your physician’s office if you have severe abdominal pain, fever, chills, excessive rectal bleeding or black stools after your procedure.

If you are unable to keep your appointment or need to reschedule, call our office at (502) 896-4711 at least 48 hours prior to your procedure.

If you are going to be late for your procedure, call the hospital’s endoscopy department. If you are scheduled at Norton Women’s & Children’s Hospital, call (502) 893-1277. If you are scheduled at Norton Brownsboro Hospital, call (502) 446-8200.

About Norton Healthcare Gastroenterology

  • Norton Cancer Institute has nine outpatient locations and multiple infusion centers in Louisville and surrounding counties and Southern Indiana. We have three radiation centers located just off major interstates, with free, self-service parking and valet parking.
  • Our gastrointestinal cancer patient navigator guides you through the treatment process. The navigator is a registered nurse and advocate for patients and families who can help coordinate scheduling to minimize your visits. The navigator provides information and support throughout your diagnosis, treatment and beyond.
  • The Norton Cancer Institute multidisciplinary approach to cancer care means you’ll have access to multiple specialists, including medical oncologists, radiation oncologists, surgical oncologists, interventional radiologists, interventional gastroenterologists, researchers, geneticists and dietitians.
  • We pull together providers from various disciplines to help identify the best treatment for you. At Norton Cancer Institute review boards, you will be considered for innovative clinical trials, immunotherapy, minimally invasive procedures, state-of-the-art radiation and advanced diagnostics.

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