Skip to main content

Endoscopic Mucosal Resection (EMR)

  • Chapter
  • First Online:
Advanced Colonoscopy
  • 1063 Accesses

Abstract

Endoscopic mucosal resection (EMR) is a method of removing superficial lesions from the gastrointestinal (GI) tract. In the colon and rectum, it is used to remove precancerous lesions as well as select cases of early submucosal cancer. In this chapter, I will discuss the indications and contraindications of EMR from a Japanese perspective, describe the basic techniques of EMR and some variations of the technique, and discuss tips and tricks as well as pitfalls of the procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kitajima K, Fujimori T, Fujii S, Takeda J, Ohkura Y, Kawamata H, et al. Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J Gastroenterol. 2004;39(6):534–43.

    Article  PubMed  Google Scholar 

  2. Ueno H, Mochizuki H, Hashiguchi Y, Shimazaki H, Aida S, Hase K, et al. Risk factors for an adverse outcome in early invasive colorectal carcinoma. Gastroenterology. 2004;127(2): 385–94.

    Article  PubMed  Google Scholar 

  3. Saitoh Y, Obara T, Watari J, Nomura M, Taruishi M, Orii Y, et al. Invasion depth diagnosis of depressed type early colorectal cancers by combined use of videoendoscopy and chromoendoscopy. Gastrointest Endosc. 1998;48(4):362–70.

    Article  PubMed  CAS  Google Scholar 

  4. Watari J, Saitoh Y, Obara T, Fujiki T, Taniguchi M, Nomura M, et al. Early nonpolypoid colorectal cancer: radiographic diagnosis of depth of invasion. Radiology. 1997;205(1):67–74.

    Article  PubMed  CAS  Google Scholar 

  5. Tanaka S, Kaltenbach T, Chayama K, Soetikno R. High-magnification colonoscopy (with videos). Gastrointest Endosc. 2006;64(4):604–13.

    Article  PubMed  Google Scholar 

  6. Karita M, Tada M, Okita K, Kodama T. Endoscopic therapy for early colon cancer: the strip biopsy resection technique. Gastrointest Endosc. 1991;37(2):128–32.

    Article  PubMed  CAS  Google Scholar 

  7. Shirai M, Nakamura T, Matsuura A, Ito Y, Kobayashi S. Safer colonoscopic polypectomy with local submucosal injection of hypertonic saline-epinephrine solution. Am J Gastroenterol. 1994;89(3):334–8.

    PubMed  CAS  Google Scholar 

  8. Uraoka T, Fujii T, Saito Y, Sumiyoshi T, Emura F, Bhandari P, et al. Effectiveness of glycerol as a submucosal injection for EMR. Gastrointest Endosc. 2005;61(6):736–40.

    Article  PubMed  Google Scholar 

  9. Fujishiro M, Yahagi N, Kashimura K, Mizushima Y, Oka M, Enomoto S, et al. Comparison of various submucosal injection solutions for maintaining mucosal elevation during endoscopic mucosal resection. Endoscopy. 2004;36(7):579–83.

    Article  PubMed  CAS  Google Scholar 

  10. Endoscopic Classification Review Group. Update on the paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy. 2005;37(6):570–8.

    Article  Google Scholar 

  11. Tappero G, Gaia E, De Giuli P, Martini S, Gubetta L, Emanuelli G. Cold snare excision of small colorectal polyps. Gastrointest Endosc. 1992;38(3):310–3.

    Article  PubMed  CAS  Google Scholar 

  12. Horiuchi A, Nakayama Y, Kajiyama M, Tanaka N, Sano K, Graham DY. Removal of small colorectal polyps in anticoagulated patients: a prospective randomized comparison of cold snare and conventional polypectomy. Gastrointest Endosc. 2014;79(3):417–23.

    Article  PubMed  Google Scholar 

  13. Yamamoto H, Sekine Y, Higashizawa T, Kihira K, Kaneko Y, Hosoya Y, et al. Successful en bloc resection of a large superficial gastric cancer by using sodium hyaluronate and electrocautery incision forceps. Gastrointest Endosc. 2001;54(5):629–32.

    Article  PubMed  CAS  Google Scholar 

  14. Yamamoto H, Kawata H, Sunada K, Satoh K, Kaneko Y, Ido K, et al. Success rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate. Gastrointest Endosc. 2002;56(4):507–12.

    Article  PubMed  Google Scholar 

  15. Ishiguro A, Uno Y, Ishiguro Y, Munakata A, Morita T. Correlation of lifting versus non-lifting and microscopic depth of invasion in early colorectal cancer. Gastrointest Endosc. 1999;50(3): 329–33.

    Article  PubMed  CAS  Google Scholar 

  16. Rutter MD, Nickerson C, Rees CJ, Patnick J, Blanks RG. Risk factors for adverse events related to polypectomy in the English Bowel Cancer Screening Programme. Endoscopy. 2014;46(2):90–7.

    Article  PubMed  Google Scholar 

  17. Conio M, Ponchon T, Blanchi S, Filiberti R. Endoscopic mucosal resection. Am J Gastroenterol. 2006;101(3):653–63.

    Article  PubMed  Google Scholar 

  18. Tanaka S, Haruma K, Oka S, Takahashi R, Kunihiro M, Kitadai Y, et al. Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm. Gastrointest Endosc. 2001;54(1):62–6.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Motohiko Kato M.D., Ph.D. .

Editor information

Editors and Affiliations

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Video 3.1 Endoscopic Mucosal Resection (EMR) of 18 mm Polyp in the Ascending Colon: A 18 mm flat polyp (type IIa of Paris classification) is visualized in the ascending colon. The polyp is positioned at 7 o'clock. Narrow band imaging (NBI) reveals a type II lesion of NICE classification consistent with low-grade adenoma. A submucosal injection using 10 % glycerine is performed achieving a high lift of the polyp. The polyp is snared in one piece, and the EMR wound is closed with endoclips. Given the en bloc resection, a precise histopathological analysis is possible (M4V 22926 kb).

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Kato, M. (2014). Endoscopic Mucosal Resection (EMR). In: Sonoda, T. (eds) Advanced Colonoscopy. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1584-2_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1584-2_3

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1583-5

  • Online ISBN: 978-1-4939-1584-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics