May 27, 2023

Modern techniques for treating digestive diseases reduce pain & recovery time

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Intestinal polyps

Cleveland Clinic gastroenterologists and oncologists are using new tools and techniques that require no stitches or long recovery times to treat digestive diseases.

EMR, short for Endoscopic Mucosal Resection, is one of the most successful and widely used techniques. It involves elevating the lesion either with submucosal injection of a solution or with cap suction, and then removing it with a snare. Most lesions smaller than 20 mm can be removed in one piece. Larger lesions are removed in multiple pieces (ie, piecemeal).

ESD, short for Endoscopic Submucosal Dissection, is a relatively newer technique that is used for en-bloc (all together) resection of larger lesions. This is a more technically demanding technique that uses the same submucosal injection method but instead of a snare a cautery knife is used to meticulously dissect the submucosa. The lesion is resected in one piece allowing for precise pathology examination of the borders of resection.

Both EMR and ESD can be used to treat patients suffering from digestive diseases such as colon polyps or Barrett’s Esophagus.

A colon polyp is a lump on the lining of the colon (large intestine) which can be flat against the large intestine or raised. If the polyp is flat, it is more likely to be cancerous. These are typically found during a colonoscopy. During the procedure, a thin flexible tube with a tiny camera called an endoscope is used to pass through small surgery tools to reach and remove the polyps.

“Many patients and physicians may not be familiar with EMR/ESD or do not have access to it locally, so these polyps are often removed using traditional surgery,” says Cleveland Clinic gastroenterologist Tolga Erim, DO – who specializes in advanced endoscopy techniques. “But EMR/ESD gives patients another choice. There is low risk of bleeding and perforation, no pain and minimal recovery time compared to surgery – it feels like just another endoscopic procedure to the patient.”

For Barrett’s esophagus – an irritation in the lining of the esophagus caused by chronic reflux of the contents from the stomach and small intestine into the esophagus – EMR involves removing abnormal areas of the Barrett’s lining by the use of an endoscopically placed snare (similar to what is used for colon polyps). ESD can do this removal in single piece. Unlike other endoscopic techniques, EMR/ESD allows for tissue confirmation by a pathologist.

Barrett’s esophagus may lead to the development of cancer of the esophagus (esophageal adenocarcinoma) in a small number of patients, which develops through a sequence of changes in the cells of the esophagus known as dysplasia, which can only be detected by endoscopic biopsies. Patients with Barrett’s esophagus should have regular surveillance exams to detect cancer at an early and potentially curable stage.

“We’ve treated patients from across the globe,” Dr. Erim says. “Because of our expertise and experience with EMR/ESD, this is the appropriate place to come for hard-to-treat polyps and other digestive diseases. We’ve become a referral center for it.”

Once an EMR or ESD procedure is over, the patient should avoid strenuous activity that day and can resume normal activity and exercise the next day. The patient’s diet will need to be altered so that they eat soft foods and drink fluids for the day following the procedure. After about six to twelve months, a follow-up appointment is needed to check the resection site. After a follow-up procedure with the specialist who performed the EMR or ESD, patients can return to their regular physician.

About Cleveland Clinic Florida

Cleveland Clinic Florida, located in Weston, West Palm Beach, Atlantis, Palm Beach Gardens and Parkland, is a not-for-profit, multi-specialty, academic medical center that integrates clinical and hospital care with research and education. Cleveland Clinic Florida has 255 physicians with expertise in 55 specialties. The medical campus is fully integrated and includes diagnostic centers, outpatient surgery and a 24-hour emergency department located in the state-of-the-art hospital. Cleveland Clinic Florida ranked #1 among the best hospitals in the Miami-Fort Lauderdale metro area and fifth in Florida in US News & World Report’s 2016-2017 ranking of Best Hospitals metro area rankings. Cleveland Clinic Florida is an integral part of Cleveland Clinic Ohio, where providing outstanding patient care is based upon the principles of cooperation, compassion and innovation. Physicians at Cleveland Clinic are experts in the treatment of complex conditions that are difficult to diagnose. For more information about Cleveland Clinic Florida, visit Follow us on Twitter and Facebook.

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