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This section illustrates the EMR process with videos from my EMR procedure.
This is the initial view of the lesion, which measures about 5 cm (2 inches) in the longest diameter. The surface pattern of the tumor looks uniform and there is no erosion or ulceration. Endoscopically the tumor is most likely to be adenomatous (i.e. not cancer).
Saline (salt water) is injected into the tissue under the tumor to expanded it and raise the tumor from the colon wall. The salt water contains indigo carmine so the solution is tinted with a slight blue color. Thus, we know that as long as there is blue area seen, we are in the correct plane and we don't need to worry about perforation. The wall of the colon is normally only 4 mm thick but is now much thicker with the cushion of salt water. Thus, there is a lot more margin of safety. Plus, the salt water absorbs the heat from the cautery so the cauterization burn does not damage the muscle layers (see the cauterizing step below).
This is the first cut using a snare. The first piece of the tumor is removed at its edge.
Numerous additional tumor cuts are performed until the tumor is gone. The blue plane is the submucosa.
Small blood vessels are cauterized to minimize the chance of bleeding after going home.
This is the resected area. The tumor is completely removed.
I went back three months after the EMR procedure for a followup colonoscopy. This is what the resected site looks like at three months. It looks completely healed.