Endoscopic Mucosal Resection - An Overview

Introduction:

Endoscopic mucosal resection is a minimally invasive procedure to remove cancerous and precancerous lesions from the gastrointestinal tract using an endoscope. An endoscope is a thin, flexible tube inserted into the gastrointestinal tract with a camera.

This technique removes the cancerous and precancerous lesions with the help of an electrical snare, a thin wire inserted through the endoscope. The electrical trap forms a loop at the end and tightens around the tumor. When an electrical current passes through the wire, it separates the tumor and cauterizes the wound.

Endoscopic mucosal resection is always performed by a gastroenterologist (who specializes in treating gastrointestinal diseases). It can also help to remove polyps from the gastrointestinal tract.

What Is an Endoscope?

An endoscope is a thin, flexible tube that comprises a camera that helps to visualize inside the gastrointestinal tract. It allows the doctor to see inside the body with a high degree of detail. The endoscope can be inserted either from the mouth or the anus, depending upon the location of the lesion to be removed.

Which Conditions May Need Endoscopic Mucosal Resection?

Endoscopic mucosal resection is done for tumors located within the mucosa (mucus membrane that lines the organs of the gastrointestinal tract. Some of the conditions where endoscopic mucosal resection is adequate are:

• Abdominal tissue regions with precancerous or superficial cancerous lesions have clear margins and can be separated from the surrounding tissues of the body. Some gastric and small intestine lesions come in this category of tumors.

• Tumors that are less than 2 centimeters in diameter or may be slightly larger but have not reached the deeper layers of the gastrointestinal wall.

• In its initial stages, esophageal or colon cancer can be removed through endoscopic mucosal resection.

• Barrett's Esophagus: it is a complication that is followed after GERD (gastroesophageal reflux disease). In this condition, the lining of the esophagus heals abnormally and changes from cells that resemble skin to cells that look like intestinal cells.

Tumors that are larger or have reached deeper layers should not be removed through endoscopic mucosal resection as it may leave traces or remove the tumor partially. In such cases, it is advised to use the endoscopic submucosal dissection (ESD) technique or the EFTR (endoscopic full-thickness resection).

How to Prepare for Endoscopic Mucosal Resection?

Some of the essential steps which should be taken before starting the procedure of endoscopic mucosal resection are:

• In cases of resection in the upper gastrointestinal tract, it is advised not to eat or drink for almost 12 hours before the procedure to ensure that the esophagus is clear from food.

• In lower gastrointestinal tract procedures, the patient should follow a liquid diet and take a laxative to clear the bowel of any food or feces.

• If the patient has any allergies, they should inform the doctor before the treatment procedure.

• The patient should not visit the hospital alone for the procedure. There should be someone with the patient to drive them home after the procedure, as few medications are given during the endoscopic mucosal resection, which may make the patient sleepy.

• The instructions given by the doctor before the procedure should be followed properly. Immediately inform the doctor of any confusion or complications before the procedure.

How Is the Procedure of Endoscopic Mucosal Resection Carried Out?

The process of endoscopic mucosal resection is carried out in the following steps:

• Sedation is given to the patient through an intravenous route, so they do not feel pain.

• A high-definition endoscope is inserted either through the mouth or the anus, depending on the location of the tumor to be resected.

• The doctor then observes the images on the screen so that any damage to the surrounding tissues can be avoided.

• The doctor then separates the tumor from the surrounding tissues by either lifting it with suction or by injecting a saline solution underneath the tumor.

• Then a thin wire is fed through the endoscope, which makes a loop around the base of the tumor. The electric current present in the wire cuts away the tumor and also seals the cut at the same time.

• The tumor is then retrieved with suction or with the help of a special retrieval tool and removed through the endoscope. If the tumor is large, it is released in pieces.

What Complications Can Occur During Endoscopic Mucosal Resection?

Some of the risk factors which can occur during the procedure are:

• Bleeding: Bleeding is the most common complication that may arise during endoscopic mucosal resection. However, it can be easily detected and corrected during the process.

• Puncture (Perforation): Depending on the size of the lesion removed, there might be slight chances of perforation in the gastrointestinal tract.

• Shrinkage (Narrowing) Of the Esophagus: Removal of a lesion that encircled the esophagus develops the risk of narrowing due to scarring. This may lead to difficulty in swelling and may need further treatment.

What Are the Side Effects of Endoscopic Mucosal Resection?

Some of the side effects which can be experienced while recovering from the endoscopic mucosal resection are:

• In cases where intestines or stomach are treated through endoscopic mucosal resection, stomach upset or vomiting.

• Some people may complain of a sore throat if the endoscope is passed through the mouth during recovery.

• If the doctor had inflated the abdomen with air during the procedure, there might be side effects like excessive gas, cramping, and bloating.

When to Call a Doctor After Endoscopic Mucosal Resection?

Several symptoms are alarming after the procedure and should be immediately informed to the doctor. These include:

• Chills.

• Fever.

• Black stool.

• Presence of bright red-colored blood in the stool.

• Vomiting.

• Fainting.

• Shortness of breath.

• Abdominal or chest pain.

Conclusion:

Endoscopic mucosal resection is a minimally invasive method to remove cancerous and precancerous lesions and tumors from the gastrointestinal tract. The technique is a simple and less hectic way of removing tumors. The recovery is also quick in such cases as minimal tissue destruction.