Introduction
This information has been produced to provide you with details about
a procedure called ‘endoscopic mucosal resection’ (EMR). This
procedure is used to remove large polyps. This information aims to
answer any concerns that you may have. Please do not hesitate to
contact the Lancashire Bowel Cancer Screening Programme office
on 01253 953014 or 01253 952855 if you have any further questions
or concerns.
What is a polyp?
A polyp is a small wart like growth that sometimes forms on the
lining of the bowel. If left to grow, polyps can sometimes turn
cancerous. By removing any polyps, your risk of developing bowel
cancer is greatly reduced.
Why have I been referred for EMR?
• We have found a polyp in your bowel. Some polyps are
very easy to remove, but in your case the polyp is larger
than average or it has a broad base and requires the ‘EMR’
technique. This is generally considered the simplest and most
straightforward method for removing this sort of polyp.
You will receive the bowel preparation and instructions before your
procedure. Please take time to read the information and follow the
instructions.
Important: You must not undertake foreign travel, flights or
long car journeys where you are the driver for 14 days following
your procedure. This is due to the risk of bleeding after large
polypectomy / EMR. Therefore, you will need to advise the
Specialist Screening Practitioner of any planned travel before booking your procedure.
The EMR procedure can take longer than a standard colonoscopy
– this can vary depending on the size and position of the polyp, but
can take up to an hour or more. A sedative injection is recommended
to help you relax during the test or you may have Entonox (Gas and
Air). Most patients find EMR comfortable – if this is not the case you
can tell the colonoscopist and more sedation can be given, or the
test can be stopped.
For an EMR, the endoscopist will do four things:
• Use the endoscope (camera) to find the polyp, which has
previously been detected in your bowel.
• Assess whether EMR is the best way to remove the polyp.
• This will be carried out using endoscopic equipment which
can remove part, or all, of the polyp. The polyp is raised using
an injection of fluid to make it easier to remove, followed by
diathermy (a form of heat treatment).
• When the examination is finished the endoscope will be
removed quickly and easily.
EMR carries the same risks of standard colonoscopy. These are
explained in the colonoscopy information leaflet. However because
of the technical nature of EMR, the risk of perforation or bleeding
is slightly higher (although still very uncommon). In general EMR is
considered the safest technique for removing this sort of polyp.
The main risks are:
• Perforation – this means tearing a hole in the bowel. For EMR,
this occurs about once in every 100 patients. Occasionally
perforations heal with antibiotics and sometimes they can be
treated with the endoscope. However usually an emergency
operation is required. As with any bowel operation, a stoma
(bag on your abdomen) is occasionally required, although this
would usually be temporary.
• Bleeding – bleeding may occur once in every 50 or 100 patients
(1-2%). Sometimes bleeding occurs during the test, but it can
occur up to 14 days after the procedure. If bleeding does occur,
it often stops on its own. However, very occasionally it requires
a blood transfusion or further endoscopies. Very rarely an
emergency operation may be necessary to stop it.
• Incomplete removal – sometimes the endoscopist cannot
remove all of the polyp for technical reasons – if this happens
you may need to have a further colonoscopy or an operation
might be planned at a later date.
You will be able to rest in the recovery area until the immediate
effects of the medication have worn off. The Specialist Screening
Practitioner will provide you with the aftercare leaflet and discuss the
findings with you.
Most patients can go home the same day. If you have had sedation
for the procedure you will need to be accompanied home and have a
responsible adult at home with you for that day, and overnight.
Sometimes (for example if the polyp was very large, or if you live
a long distance from the hospital) the colonoscopist might advise
that you stay in hospital overnight as a precaution. Please bring an
overnight bag with you in case this is recommended
You will be contacted by the Bowel Cancer Screening Specialist
Nurse the next working day to check on how you are feeling
following your colonoscopy.
Once the results are available you will be contacted by a member
of the Bowel Cancer Screening Team and offered a nurse led clinic
appointment. This should be within 3 weeks.
In general you will be advised of the need for a further colonoscopy
procedure between 3-6 months after the EMR to check all the polyp
has gone – this is usually a quick procedure.
In this case, the Screening Colonoscopist will discuss other options
with you which may include an operation to remove the polyp.
