Polypectomy and Endoscopic Mucosal Resection (EMR)

What is a polypectomy?

Endoscopic polypectomy is a minimally invasive procedure used to remove polyps—abnormal growths of the lining of the digestive tract, most commonly arising in the colon—during a colonoscopy or upper endoscopy. Most polyps are benign, but some are considered pre-malignant, meaning they have the potential to develop into cancer or may harbour early cancer. Removing these polyps significantly reduces the risk of bowel cancer, as most bowel cancers arise from polyps.

What is endoscopic mucosal resection (EMR)?

EMR is a specialised technique used to remove larger or higher-risk polyps or lesions from the gastrointestinal (GI) tract without surgery. It involves:

  • Careful inspection of the polyp or lesion.

  • Injecting fluid beneath it to lift it away from the underlying tissue.

  • Removing the lesion with a wire snare, often using diathermy (heat). In large polyps, treating the edges of the resected tissue with diathermy is performed to reduce the risk of regrowth. Placement of internal clips is often performed to minimise the risk of bleeding.

  • Tissue removed during EMR is sent for analysis under a microscope to determine the type of polyp and whether any early cancer is present.

Is it painful?

Polypectomy and EMR are not usually painful. You may feel bloated or experience mild cramping due to the air introduced into the digestive tract during the procedure. Any discomfort typically settles quickly and responds well to simple pain relief such as paracetamol. Severe or persistent pain may indicate a complication and you should seek immediate medical attention via your local emergency department and contact Dr Clark-Dickson.

What is the preparation?

Preparation is the same as for a standard colonoscopy or gastroscopy:

  • Fasting before the procedure.

  • Bowel preparation if the procedure involves the colon (you will be provided with information regarding this).

  • Please let Dr Clark-Dickson know if you take any blood-thinning medications (e.g. aspirin, clopidogrel, ticagrelor, warfarin, apixaban, rivaroxaban, or dabigatran), as these may need to be adjusted before the procedure to reduce the risk of bleeding.

What are the risks?

  • Polypectomy is generally very safe with a very low risk of bleeding or perforation (a tear in the bowel wall).

  • EMR, which is performed on larger or higher-risk lesions, carries slightly higher risks:

    • Risk of perforation: 1–2%

    • Risk of delayed bleeding: up to 7%

These risks are still low, and precautions are taken to minimise them.

What happens afterwards?

Once you are fully awake, I will discuss the findings with you and provide a written report.

  • After simple polypectomy, you can usually eat and drink normally.

  • After EMR, you may need to remain on clear fluids until the following morning to reduce the risk of complications.

I will discuss your pathology results and any follow-up care required during a follow-up appointment or phone consultation.

When should I seek help after a polypectomy or EMR?

You will be given written instructions before going home. Contact your healthcare provider or seek emergency medical care if you experience:

  • Fever or chills

  • Vomiting, especially if it looks like coffee grounds or contains blood

  • Black or tarry stools

  • Bright red blood in the stool

  • Severe or persistent abdominal pain