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Esophageal Endoscopic Mucosal Resection (EMR)
for Dysplastic or Neoplastic Barrett's disease

This guide is for patients who are going to have esophageal endoscopic mucosal resection for dysplastic or neoplastic Barrett's disease. The procedure is also called EMR. The guide answers some of the most commonly asked questions about EMR. Please ask your doctor or nurse for more information.

What is an EMR?

An EMR is a procedure involving the use of an endoscope, which is a lighted, flexible tube about the thickness of your finger. The doctor will pass the tube through the mouth to the back of the throat into the esophagus, stomach and duodenum (the first part of the small intestine). During the EMR the doctor will inject a solution into the lining of the esophagus or stomach to raise a lesion and separate it from the deep muscle layer. After the lesion is raised for safety purposes, the doctor will remove the tissue for examination in the laboratory.

Preparing for your procedure

Because you will be sedated, you will not be able to drive after your EMR. You MUST arrange for a responsible adult (over 18) who can drive or otherwise accompany you to and from the endoscopy unit. Your procedure cannot begin until a responsible adult driver is in the unit. This person should remain in the unit during your entire visit so that they are available as soon as you are ready to be discharged. You will not be discharged unless this person is in the unit. Because your judgment may be impaired after this procedure, you will not be released to take public transportation, a taxicab, or even walk home without another responsible adult present to accompany you.

Please contact your primary care physician or insurance company if prior referral is needed.

The procedure will take about 60 minutes, but expect the visit to the endoscopy unit to last two to three (2–3) hours to allow for preparation and recovery.

You may have your normal diet the day before the procedure. Do not eat any solid food or drink any non-clear liquids, such as milk or orange juice, for six (6) hours before your scheduled appointment time. You may drink clear liquids such as water or black coffee up to two (2) hours before your procedure. Take your usual medicines no later than four (4) hours before your appointment. If you are taking pain medicine, you may do so up to four (4) hours before your procedure.

If you are taking any anticoagulant medicines (blood thinners), including aspirin or nonsteroidal antiinflammatory drugs, please tell the doctor who ordered your procedure. Your medicine may need to be adjusted the week before your procedure. Patients usually stop taking anticoagulant and antiplatelet medicines for three (3) to five (5) days, but you MUST discuss this with the doctor who ordered this medicine before stopping it.

You should not take antiplatelet medicines for five (5) days before your appointment as this type of medicine may increase bleeding. You must discuss this with the doctor who ordered this medicine before stopping the medicine.

Here are the names of some common antiplatelet medicines:

Be sure to tell the doctor who ordered your procedure if you are taking Coumadin or other blood thinners. You will need special instructions.

If you have an implanted cardiac defibrillator (ICD), please call 734-936-9250 (option 1) as soon as possible with the ICD name and manufacturer.

The day of the procedure – important information

1. Your procedure is scheduled for:

Date:______________________ Time:________________________

If you are unable to keep your appointment, please call the endoscopy scheduling center at 734-936-9250 (option 1) as soon as possible.

2. A map guiding you to the Medical Procedures Unit (MPU) at University Hospital has been mailed to you or you may find it online; click on this link. This procedure is performed only at the Medical Procedures Unit (MPU) at University Hospital.

Please be certain that you are scheduled to come to the main hospital. Call the call center at 734-936-9250 (option 1) if you are unsure.

3. Please bring the following with you on the day of your procedure:

Your procedure will not begin until the nursing staff speaks with the responsible adult who will take you home. You will not be discharged until this person is in the unit to escort you from the endoscopy unit. You will not be able to drive for at least 12 hours.

4. If you have diabetes and take oral diabetes medications (pills): Do not take the medicine the morning of your test. Bring your diabetes medicine with you.

5. If you have diabetes and take insulin: On the morning of your test: take half (½) of your usual dose of long-acting insulin. Long-acting insulins include NPH, Humulin N, Humulin 70/30, Humalog Mix 75/25, Lantus, and Levemir. If you take Humulin R 500 insulin, take only half (½) of your usual dose. Do not take short-acting insulin the morning of the test. Short-acting insulins include Regular, Humulin R, and Novolin R. Take the other half (½) of your long-acting insulin and any regularly scheduled dose of short-acting insulin right after the test. Be sure to eat your usual meal at that time. Please review the handout Instructions for Patients with Diabetes Having Outpatient Procedures/Tests, which the ordering doctor will give you. You can find this handout online; click on this link Instructions for Patients with Diabetes Having Outpatient Procedures/Tests.

6. Please leave jewelry at home.

7. Small children will be more comfortable at home.

The procedure

In the reception area or preparation area you will answer questions about your health history, current medicines, and allergies. You will sign a consent form. After you change into a hospital gown, a nurse will start an intravenous (IV) line. The IV line is used to give you medicine to make you more comfortable during the procedure. The procedure is performed in a room specially designed for endoscopic procedures. Equipment that will help the nurse and doctor monitor your heartbeat and breathing will be connected to you. Your throat will be numbed with a spray and you will be sedated before the doctor passes the tube through your mouth into your stomach. You will be able to breathe normally and burp if needed during the procedure. There usually is no pain associated with this test, even when the tissue is removed from the stomach.

Potential complications

There are potential complications associated with all medical procedures. Some of the potential complications of EMR are bleeding from the specimen site and perforation (a hole in the lining of the gastrointestinal tract). These will be explained to you at the time you sign your consent for the procedure.

Your doctor

A doctor specially trained in EMR will perform the procedure. The doctor who ordered your procedure will make decisions regarding your plan of care after the procedure.

Recovery

After your procedure you will be taken to the recovery area. One adult person who came with you to your procedure may join you there, if you wish. Before you go home the doctor who performed your EMR will discuss what happened during the procedure and what will be your next treatment plan. The nurse will review your discharge instructions with you. You will be given the report from your procedure. You may NOT drive yourself home. Be sure to bring a responsible adult licensed driver with you. A responsible adult must be with you when you are discharged from the recovery area. You may want a family member or friend to stay with you for the rest of the day. Your diet will be altered after the EMR. You will start with fluids and soft foods. A detailed diet plan will be given to you in writing when you are discharged from the endoscopy unit. You will be given an opportunity to ask questions while you are in the endoscopy unit.

At-home instructions

You will be given specific written instructions about resuming your activity, medicines, and diet.

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UMHS Medical Procedures Unit - October 2012