Esophageal Endoscopic Mucosal Resection (EMR)
for Dysplastic/Neoplastic Barrett’s Disease
This guide is for patients who are going to have Esophageal Endoscopic Mucosal Resection for dysplastic/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, a lighted, flexible tube, about the thickness of your finger. The doctor will pass the tube through the mouth and 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 that 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 sixty (60) minutes, but expect the visit to the endoscopy suite to last two to three (2-3) hours to allow for preparation and recovery.
Because you will be sedated, you MUST arrange for a responsible adult (age 18 years or older) to accompany you from the endoscopy unit after your procedure. This person should remain near the unit during your entire visit. That person needs to be available as soon as you are ready to be discharged. You will not be discharged until that person is in the endoscopy unit. You may not travel by taxi or public transportation after your procedure unless you have a responsible adult to accompany you.
You may have your regular diet the day before the procedure. Do not eat any solid food or non-clear liquids, such as milk or orange juice, for six (6) hours prior to your scheduled appointment time. You may drink clear liquids such as water or black coffee up to two (2) hours before your test. Take your usual medications no later than four (4) hours before your appointment. If you are taking pain medication, you may do so up to four (4) hours before the procedure.
If you are on any anticoagulant medications (blood thinners), including aspirin or non-steroidal anti-inflammatory drugs, please notify the physician that ordered your test. Your medication may have to be adjusted the week before your test. Patients are usually off anti-coagulant and anti-platelet drugs for three (3) to five (5) days, but you MUST discuss this with doctor that ordered those medications before stopping the drugs.
You should not take anti-platelet drugs for five (5) days prior to your appointment as all of these drugs may increase bleeding. You must discuss this with the ordering physician before stopping these drugs.
A few of these products include:
Anti-platelet drugs:
ReoPro (abciximab)
Aggrenox (aspirin plus dipryridamole)
Plavix (clopidogrel)
Persantine (dipyridamole)
Integrillin (eptifibatide)
Ticlid (ticlopidine)
Aggrastat (terofiban)
Be sure to tell the doctor that ordered your test if you are on 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 test — 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 the Medical Procedures Unit (MPU) has been mailed to you or is available at www.med.umich.edu/maps. This procedure is performed only at the main University Hospital, MPU. 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 EMR:
- A list of all medications you are taking
- A list of any allergies you have
- Health insurance cards
- Your blue University of Michigan hospital card
- A responsible adult must accompany you from the endoscopy suite after your procedure.
- A bi-cap or c-pap mask, if you have one
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 that person is in the unit to escort you from the endoscopy suite. You will not be able to drive for at least 12 hours.
4. If you take oral diabetes medications (pills): Do not take the medication the morning of your test. Bring your diabetes medication with you. If you take insulin (one or two injections per day): Take one-half of your usual morning dose of NPH, Lente, Novolin 70/30 or Lantus insulin and NO Regular or Humalog insulin the morning of your test. If you take Ultralente insulin or are on three or more injections per day, please contact the health care provider who manages your diabetes.
Please refer to the handout, “Instructions for Patients with Diabetes Having Outpatient Procedures”.
5. Please leave jewelry at home.
6. Small children will be more comfortable at home.
The procedure
In the reception 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 line (IV). The IV is used to give you medication 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 test. There usually is no pain associated with this test, even when the tissue is removed from the stomach.
Potential complications or risks of EMR
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 test. 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 or leave the unit by yourself. Be sure to bring a responsible adult licensed driver with you. A responsible adult will need to be with you when you are discharged from the recovery area. You should plan to have a family member or friend stay with you for the remainder 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 suite.
At-home instructions
You will be given specific written instructions about resuming your activity, medications and diet.
- You may return to work or school the day after your test
- Do not drive a vehicle or operate machinery for at least 12 hours after your test.
- Do not make any major legal or financial decisions for at least 12 hours after your test.
- Do not drink alcoholic beverages for at least 12 hours following your procedure.
- If you have questions about your procedure, please contact your outpatient nurse at (734) _________________.
U-M Health System Related Sites:
Department of Internal Medicine Division of Gastroenterology
Directions to the Medical Procedures Unit
Instructions for Patients with Diabetes Having Outpatient Tests (on insulin)
Instructions for Patients with Diabetes Having Outpatient Tests (no insulin)
Other Related Web Sites:
National Institute of Digestive Diseases - Upper Endoscopy
Your Digestive System and How it Works
Information provided by UMHS Medical Procedures Unit staff - November, 2008
