Were you scared when you heard about removing cancer cells through an endoscopy? (Endoscopic Mucosal Resection) Let's talk about this!

Have you ever had an endoscopy and the doctor said, "There's a small tumor in your stomach, we need to remove it"? Or "There's a small polyp in your colon, let's remove it before it becomes cancer"? When you hear that, you're probably thinking, "Oh, surgery?". You might be wondering if you'll have to cut your stomach, stay in the hospital for a few days, and how much pain it will cause. But you can be happy, because not everything requires major surgery anymore. Today we're going to talk about a very advanced and safe technology that removes these abnormal tissues from inside your endoscopy tube, without cutting your stomach.

What is Endoscopic Mucosal Resection (EMR)?

This name may sound a bit complicated, but it's actually quite simple. Let's call it EMR for short.

Simply put, this is not surgery. It is a procedure that removes abnormal tissue from inside your digestive tract, without making any cuts in your stomach. This abnormal tissue can be cancer cells, or it can be precancerous growths that could turn into cancer in the future.

Think of your digestive system as a long tube. The abnormal cells grow on the inside wall of this tube (we call it the mucosa). In an EMR procedure, just like you would do with an endoscopy, a long, flexible tube with a camera attached to it (an endoscope) is inserted through your mouth or rectum, into the area where the abnormal tissue is, and using small instruments that are passed through the tube, the surgeon cuts out just that piece of tissue and removes it.

This is done by a gastroenterologist. The biggest advantage of this method is that there are no external incisions, so you feel very little pain, and you can recover quickly and return to your normal life.

What types of diseases is this EMR system used for?

This method is mainly used to treat cancer and precancerous conditions. Importantly, this method is only successful if the disease is detected at an early stage . That is, when the abnormal tissue is only in the innermost layer of the wall of the esophagus.

The EMR method is most commonly used in the following situations:

• Esophageal cancer: Early stage cancer of the esophagus (the tube through which we swallow food).
• Barrett's esophagus: This is when the cells inside your esophagus change and become more likely to develop into cancer. This procedure is used to remove these abnormal cells.
• Stomach cancer: Early stage cancer that starts on the surface of the stomach wall.
• Colorectal cancer: This method is very effective in removing polyps or early stage cancer in the colon or rectum.
• Small intestine cancer: This is also used for cancer that occurs in the first part of the small intestine (duodenum).

Who is this treatment best suited for?

Your doctor will decide whether EMR treatment is right for you. It depends on several factors. The main ones are the size of the abnormal tissue and how deep it has spread .

This treatment may generally be suitable for you:

• If your abnormal tissue (tumor or mass) is small in size.
• Unless it has gone into the deeper layers of the wall of the digestive tract.

However, if the tumor is large or has penetrated deep into the wall, EMR alone may not be enough. In such cases, you may need to resort to other treatment methods.

How do you prepare for this process in advance?

Your doctor will give you a clear set of instructions on how to prepare for this, and it is very important to follow them exactly.

• For the upper digestive tract (esophagus, stomach): You will be asked to completely abstain from eating or drinking for several hours before the procedure. This is because the doctor can see clearly and safely remove tissue if the stomach is empty.
• For the large intestine (colon): For this, you will need to have a "bowel prep." The doctor will give you a special medicine ( laxative ) to drink. After you drink this, you will need to go to the bathroom frequently. Although this is a bit uncomfortable, it is essential to do this to thoroughly clean the inside of your colon. This will allow the doctor to see clearly when he inserts the tube.

What happens during the process?

We will take necessary steps to ensure that you do not feel any discomfort or pain during this process.

You will be put under general anesthesia , which means you will be completely asleep. Sometimes you will feel like you are awake, but you will not remember anything afterwards (conscious sedation) . So you will not feel or remember anything.

Then the doctor follows these steps:

1. If your upper digestive tract is affected, the treatment is done through the mouth . If your lower digestive tract is affected, the endoscope tube is slowly inserted through the anus .

2. Using the camera, the tube is directed to the exact location of the abnormal tissue.

3. Then, small surgical instruments are passed through the tube and the tissue is removed. There are several ways to do this. Sometimes the tissue is pulled up using suction, or a liquid is injected under the tissue and lifted and cut, or it is cut with an electric wire loop.

4. Carefully remove the removed piece of tissue.

This entire process usually takes 30 to 60 minutes .

What happens after the procedure?

After the treatment is over, you will be transferred to a recovery room. You will need to stay under medical supervision for a few hours until the effects of the anesthesia wear off.

• When going home: It can take up to 24 hours for the effects of the anesthesia to fully wear off, so you will definitely need someone to drive you home. You will not be allowed to drive or go home alone.
• Tissue examination: The removed tissue is sent to a laboratory. There, a pathologist examines it under a microscope and provides a detailed report, including whether it contains cancer cells, whether it was completely removed, and what its nature is.

Are there any minor side effects?

Yes, you may experience some minor discomfort for a day or two. This is normal and will go away quickly.

• Bloating
• Stomach cramps (Cramping)
• Gas pain and flatulence
• Nausea or vomiting
• Slight sore throat if the tube is inserted through the mouth

These usually heal completely within a day or two.

What are the advantages and risks of this EMR system?

As with any medical treatment, there are benefits and very minor risks.

How long does it take to heal and what should I do afterwards?

One of the biggest advantages of the EMR method is quick recovery.

• Going to work: Most people can go back to their normal activities the next day .
• Diet: Your doctor will likely recommend a liquid diet for a few days until your digestive tract heals. After that, you can gradually transition back to regular food.
• Follow-up: You will be asked to come back to see your doctor about 12 weeks after your treatment. An endoscopy will be performed to check if all the abnormal tissue has been completely removed and if the area has healed well. Based on the tissue report, a decision will be made on whether you need further treatment or not.

What are the emergencies that require calling the doctor?

If you experience any of the following symptoms after treatment, do not ignore them. Call your doctor immediately, or go to the Emergency Department (ETU) of the nearest hospital without delay.

• If you have blood in your stool (black or dark red)
• Severe chest pain
• If you feel dizzy or faint
• If you have a fever or chills and shivering
• Difficulty breathing (dyspnea)

These could be signs of the complications we discussed earlier, so it's important to seek medical attention promptly.

EMR is not a major surgery, it is a minimally invasive procedure. Modern technologies like these can help reduce the fear and anxiety that comes with knowing you have cancer or are at risk of cancer. Compared to the recovery time and pain after major surgery, EMR allows you to return to a healthy life much sooner.