Endoscopic Mucosal Resection: Before Your Procedure

Endoscopic mucosal resectionis a procedure to remove abnormal tissue or growths from the lining of the digestive tract. This lining is called the mucosa.

The digestive tract goes from the mouth to the anus. The upper digestive tract includes the mouth, throat, esophagus, stomach, and first part of the small intestine. The lower digestive tract includes the rest of the small intestine, large intestine (colon), rectum, and anus. The digestive tract is also called the gastrointestinal tract, or GI tract.

To do the procedure, your doctor uses a special tool called an endoscope (scope). This is a thin, flexible tube with a light and a camera at the end to look inside your upper or lower digestive tract. Your doctor passes the scope into your mouth, down your throat, and into your stomach or the upper part of the small intestine. Or the doctor passes the scope through your anus into your colon. The doctor uses the scope to look for abnormal tissue.

When abnormal tissue is found, your doctor injects fluid under it or uses suction to lift it away from the other tissue. Then the tissue is cut off and removed. The removed tissue is sent to a lab, where it will be checked under a microscope for cancer or other problems.

Sometimes doctors use different methods to remove the abnormal tissue. This depends on the size, shape, and location of the tissue. Talk to your doctor if you have any questions about how the procedure will be done.

Before the procedure, you will need to stop eating solid foods. If the doctor is examining your lower GI tract, you will be given instructions on how to clean out your colon. This is to help your doctor see inside your colon during the procedure.

You may get medicines through an intravenous (I.V.) line in your vein to reduce pain and to relax you or make you sleep. If the scope is put down your throat, your doctor may numb your throat with an anesthetic spray, gargle, or lozenge. You may have the procedure in a hospital or an outpatient surgery center. Most people don’t need to stay overnight in the hospital and can go home after the procedure.

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• Tell your doctors ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• If you take aspirin, some other blood thinner, or a glucagon-like peptide 1 (GLP-1) receptor agonist to treat obesity or diabetes, ask your doctor if you should stop taking it before your procedure. Make sure that you understand exactly what your doctor wants you to do. Blood thinners increase the risk of bleeding. GLP-1s may cause the stomach to empty more slowly. They also cause nausea, vomiting, indigestion, and abdominal (belly) swelling.
• Don’t smoke, vape, or use other tobacco and nicotine products. These things increase procedure risks. Your doctor may require that you quit for a period of time before and after the procedure. You have the best chance for a healthy recovery if you quit completely. If you need help quitting, talk to your doctor about quit programs and medicines.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.

• Do not eat or drink anything for 6 to 8 hours, or as directed by your doctor, before the procedure. An empty stomach helps your doctor see your stomach clearly during the procedure. It also reduces your chances of vomiting. If you vomit, there is a small risk that the vomit could enter your lungs. This is called aspiration.

• Follow your doctor's directions about when to stop eating solid foods and drink only clear liquids. You can drink water, clear juices, clear broths, flavored ice pops, and gelatin (such as Jell-O). Do not eat or drink anything red or purple. This includes grape juice and grape-flavored ice pops. It also includes fruit punch and cherry gelatin.
• Take the bowel prep as your doctor tells you. You will want to stay home because the prep will make you go to the bathroom a lot. Your stools will be loose and watery. It's very important to take all of the prep. If you have problems taking it, contact your doctor.
• Do not eat any solid foods after the bowel prep.
• Stop drinking clear liquids for a few hours before the test. Your doctor will tell you how many hours this will be.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your procedure may be canceled. If your doctor told you to take your medicines on the day of the procedure, take them with only a sip of water.
• Follow your doctor's instructions about when to bathe or shower before your procedure. Do not apply lotions, perfumes, deodorants, or nail polish.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

• Bring a picture ID.
• You will be kept comfortable and safe by your anesthesia provider. You may get medicine that relaxes you or puts you in a light sleep. The area being worked on will be numb.
• The procedure may take 30 to 45 minutes. Or it may take longer. It depends on what is found and what is done. You may stay at the hospital or surgery center for 1 to 2 hours until the medicine you were given wears off.