Endoscopic mucosal resection - removing the lining of the oesophagus

Endoscopic mucosal resection (EMR) means removing abnormal areas in the lining of the oesophagus (food pipe) or the stomach.

Your doctor uses a long flexible tube (endoscope) with a tiny camera and light on the end to look inside your oesophagus. Then they remove the abnormal area by passing special instruments through the tube.

This type of surgery is for people who have

  • very abnormal cell changes in the lining of the oesophagus (precancerous changes)
  • a very early stage cancer that is small and only in the lining of the oesophagus

What happens

You have the procedure in the endoscopy unit in hospital. You probably had an endoscopy as one of the tests to diagnose you. The preparation for an EMR is the same as for an endoscopy.

Diagram showing Oesophageal endoscopy illustration

Before the procedure

When you arrive at the clinic, the nurse may ask you to go into a cubicle to change into a hospital gown.

Your doctor will explain what they are going to do and you’ll sign a consent form. This is a good time to ask any questions you might have.

You lie down on the couch and an anaesthetist puts a small tube (canula) into your vein in your arm or hand. They attach a drip to this that contains a sedative. It takes a few minutes for you to go to sleep.

Some people need to have the procedure under a general anaesthetic. Your doctor will tell you if you need this.

During the procedure

Once you are sleepy your doctor passes the endoscope down your throat. Using the endoscope they inject fluid into the layer of cells below the cancer or abnormal area. The fluid makes the area stand out from the rest of the tissue.

Your doctor removes the area of tissue using a thin wire. They collect the tissue to look at under a microscope.

The procedure takes between 30 and 90 minutes depending on how much of the lining they need to remove.

After the procedure

You'll need to rest for a while afterwards. You won’t remember having the procedure.

It varies whether you can go home the same day or stay in hospital overnight. You need someone to take you home and be with you when you go.

You usually just drink liquids for the first couple of days after the procedure and gradually build up to a normal diet again.

You may have

  • mild chest pain like heartburn
  • mild discomfort when you eat food
  • bloating and discomfort lasting a few hours

You can take paracetamol to control any pain. Don’t take aspirin or non steroidal painkillers such as ibuprofen.

Possible risks

Your doctors will make sure the benefits of having the surgery outweigh these possible risks

  • bleeding – contact the hospital if you start bleeding from your mouth or if your poo is black
  • a sore throat that can last for up to 24 hours – contact the hospital if you have severe pain in your throat, chest or tummy (abdomen)
  • fluid going into your lungs from your mouth – this rarely happens as a nurse removes the fluid from your mouth during the procedure
  • a reaction to the sedative making you breathless
  • a small tear in the lining of your oesophagus or stomach – this is rare, treatment is antibiotics and fluids through a drip or surgery to repair the tear
  • narrowing of the oesophagus that develops a while after the procedure – if it happens you have another endoscopy to stretch the oesophagus

Follow up

At your first follow up appointment, your doctor:

  • gives you the results of the surgery
  • examines you
  • asks how you are and if you've had any problems  

This is also your opportunity to ask any questions. Write down any questions you have before your appointment to help you remember what to ask. Taking someone with you can also help you to remember what the doctor says.

How often you have follow up appointments depends on the results of your surgery. Ask your doctor how often you need to have checkups and what they will involve.

You might need more treatment if you have Barrett’s oesophagus. You usually have an endoscopy 3 months later to check that your oesophagus is healing.

Last reviewed: 
03 Oct 2019
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    Rebecca C Fitzgerald, Massimiliano di Pietro, Krish Ragunath, and others. 
    Gut published online October 28, 2013 British Society of Gastroenterology

  • Endoscopic submucosal dissection of oesophageal dysplasia and neoplasia.
    NICE interventional procedure guidance [IPG355], September 2010.

  • Guidelines for the management of oesophageal and gastric cancer.
    WH Allum and others.
    Gut. 2011, Nov; 60(11):1449-72.

  • Oesophago-gastric cancer: assessment and management in adults  [NG83]
    National Institute for Health and Clinical Excellence (NICE)
    Published January 2018

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    J Lagergren and others
    The Lancet Vol 390, November 25th 2017