NCCN Guidelines for Patients® | Esophageal Cancer - page 29

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NCCN Guidelines for Patients
®
: Esophageal Cancer
Version 1.2013
Part 4: Overview of cancer treatments
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Definitions:
endoscope:
A thin, long
tube through which tools
are inserted to do work in
the digestive system
sedated:
A state of
relaxation caused by drugs
submucosa:
The second
layer of the esophageal
wall
4.1 Endoscopic treatment
EMR
EMR removes very small tumors and nearby tissue using tools inserted through
an endoscope. There is more than one type of EMR. All types find and mark the
edges of the tumor and remove the tumor with a wire loop, called a snare. EMR
types mainly differ by whether suction is used.
Injection EMRs do not use suction. Instead, a liquid is first injected underneath
the tumor to raise and separate it from the submucosa. For the “inject-and-cut”
method, a braided snare is then used to cut the tumor off of the esophagus. The
inject-and-cut method is also called submucosal injection polypectomy. For the
“inject, lift, and cut” method, small tongs are used to grasp and guide the raised
tumor into the snare for removal. The inject, lift, and cut method is also called a
strip biopsy.
Simple-snare, cap, and ligation EMRs do use suction. The simple-snare EMR
uses suction to raise the tumor into a stiff snare that is pressed down around the
tumor. A cap EMR raises the tumor with an injection, and then uses suction to
draw the tumor into a cap that is at the tip of the endoscope. A snare in the cap
is used to remove the tumor. A cap EMR is called the “suck and cut” method.
A ligation EMR uses suction to draw the tumor into a band that is tightened to
tie off the tumor from the esophagus. A snare is then used to cut off the raised
tumor. A ligation EMR is called the “suck-band-and-ligate” method.
EMR requires that you be sedated. You may have a reaction to the sedative
and become nauseated or vomit. EMR may cause a sore throat, pain in the
chest, or gas. More serious but less common problems are bleeding, a tear
through the esophageal wall, or narrowing of the esophagus. In most cases
you’ll be able to go home after the sedative wears off, but you shouldn’t drive
or return to work.
Acronyms:
EMR
=
endoscopic mucosal
resection
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