Endoscopic mucosal resection of colorectal polyps

Endoscopic mucosal resection (EMR) is an advanced endoscopic technique used to remove large polyps (growth in the inner layer of the bowel). This involves injection of a special fluid to lift the polyp away from the underlying muscle, followed by removal with a snare.

Removal of large colorectal polyps that are deemed suitable for endoscopic resection.

Preparation for colonic EMR is the same as that for colonoscopy. Please refer to the colonoscopy instructions on bowel preparation.

People with diabetes, heart valve disease, cardiac pacemakers, on weight loss drugs (e.g. Ozempic, Wegovy, Mounjaro, Trulicity, Saxenda), or on blood thinning medication e.g. Apixaban, Rivaroxaban, Dabigatran, Warfarin, Clopidogrel, Ticagrelor, Prasugrel (except Aspirin), may require special arrangements, which should be discussed with your Gastroenterologist.

• Arrive at the Endoscopy Unit at the time you are advised. Do not bring any valuables.

• You will be admitted by a nurse. After which, your Gastroenterologist and the Anaesthetist will speak with you.

• Deep sedation is administered by an Anaesthetist prior to the procedure so that you remain comfortable.

• The procedure time generally takes around 45-90 minutes, depending on the size and number of polyps.

• After the procedure, you will be taken to the recovery area until the sedation wears off.

• Your Gastroenterologist will briefly inform you of the findings of your procedure and necessary, a follow-up appointment will be organised to discuss the results in detail. Surveillance colonoscopy will be recommended at a suitable interval by your Gastroenterologist (usually 3 to 6 months).

• Due to the sedation, within the first 24 hours of the procedure, you must AVOID driving, travel alone on public transport or taxi/uber, operate machinery, sign legal documents or consume alcohol. An adult must accompany you home after the procedure and stay with you overnight.

• After 24 hours, you can return to work and resume normal activities.

EMR is an advanced endoscopic procedure for removal of large polyps and therefore carries higher risk than diagnostic endoscopy.

• Risk of perforation is approximately 1%. If identified early, this may be managed with endoscopic clip closure, otherwise surgery may be required.

• Post-polypectomy syndrome (significant pain) can occur in 1%.

• Significant bleeding, including delayed bleeding (up to 2 weeks later) can occur in over 5% and may require blood transfusion, repeat endoscopy, radiological treatment or surgery.

Like all medical procedures, there is a remote chance that a significant complication can result in death, however this is extremely rare.