Endoscopic Mucosal Resection (EMR) for Patients Participating in The Lancashire Bowel Cancer Screening Programme

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.

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 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.