Name of the Procedure:

Esophagogastroduodenoscopy, flexible, transoral; with endoscopic mucosal resection
Common name: EGD with EMR

Summary

An Esophagogastroduodenoscopy (EGD) with Endoscopic Mucosal Resection (EMR) is a procedure where a flexible tube with a camera (endoscope) is inserted through the mouth to examine the esophagus, stomach, and the beginning of the small intestine. During the procedure, abnormal tissues can be removed for further examination.

Purpose

This procedure is used to identify and remove abnormal growths or early-stage cancers in the upper digestive tract. It aims to diagnose and treat conditions such as Barrett’s esophagus, polyps, and early gastric cancer by removing abnormal mucosal tissues.

Indications

• Unexplained digestive symptoms like difficulty swallowing, persistent heartburn, or abdominal pain.
• Identification and treatment of abnormal growths seen during initial endoscopy.
• Barrett’s esophagus with high-grade dysplasia.
• Early-stage esophageal or gastric cancer.

• Precancerous conditions of the esophagus, stomach, or upper small intestine.

  Preparation

• Fasting for at least 6-8 hours prior to the procedure.
• Temporary cessation of certain medications such as blood thinners, as advised by the doctor.
• Pre-procedure diagnostic tests like blood work and imaging studies may be required.

Procedure Description

1. The patient receives sedation or anesthesia for comfort.
2. A flexible endoscope is gently inserted through the mouth and guided down the esophagus, into the stomach, and into the duodenum.
3. The doctor examines the areas of interest using the camera on the endoscope.
4. If abnormal mucosal tissue is identified, instruments passed through the endoscope remove the tissue (mucosal resection).
5. The tissue is retrieved for pathological examination.
6. Any necessary post-resection treatments, such as cauterization to prevent bleeding, are performed.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

The procedure is usually performed in a hospital endoscopy suite or an outpatient surgical center.

Personnel

• Gastroenterologist or Endoscopy Specialist.
• Anesthesiologist or Nurse Anesthetist.
• Endoscopy Nurses.
• Pathologist (for tissue examination).

Risks and Complications

• Common: Sore throat, mild bloating, or discomfort.
• Less common: Bleeding, infection, perforation of the digestive tract, adverse reactions to sedation.
• Rare: Pancreatitis, severe bleeding.

Benefits

• Early detection and removal of potentially cancerous tissues.
• Minimally invasive compared to surgical alternatives.
• Immediate visualization and treatment of abnormalities.
• Quick recovery with minimal discomfort.

Recovery

• Patients are observed for a few hours post-procedure to ensure sedation has worn off.
• Instructions for dietary restrictions for the first 24 hours.
• Avoid strenuous activities for a few days.
• Follow-up appointments for results and further treatment plans if necessary.

Alternatives

• Regular surveillance endoscopy without mucosal resection.
• Surgical resection (more invasive, longer recovery).
• Ablative therapies like radiofrequency ablation (RFA).
• Each alternative varies in invasiveness, recovery time, and effectiveness.

Patient Experience

During the procedure, patients usually feel relaxed and sleepy due to sedation. Post-procedure, patients might have a mild sore throat and feel slightly bloated. Any discomfort is usually short-lived and manageable with mild pain relievers.