Endoscopic mucosal resection for large polyps.

Large, flat polyps and early tumours confined to the inner lining (mucosa) can often be removed without surgery. In mucosal resection, the lesion is lifted with fluid and removed with a snare through the endoscope.

  • No external incision
  • For large, flat polyps
  • Statutory insurance at the Bürgerspital

5,888 reviews on ProvenExpert

  • 2 cmor larger: usually removed in several pieces
  • Outpatientor overnight, depending on size and location
  • 6months until the removal site is checked
  • Resultsfrom the laboratory determine the next steps

Approximate figures based on the German S3 guideline on colorectal cancer. The findings show how things will proceed in your case.

Mucosal resection

Removing the lining with precision.

The mucosa is the innermost layer of the wall of the oesophagus, stomach and bowel. Many precursors of bowel cancer and some very early tumours initially grow only in this layer. Endoscopic mucosal resection, or EMR for short, removes them precisely – through an endoscope and without an external incision.

For most polyps, forceps or a simple snare are sufficient during a colonoscopy. Large, flat or broad-based lesions, by contrast, lie close against the bowel wall and can hardly be captured completely in this way. EMR is intended for them – in the colon often for polyps from about two centimetres. It is also used in the oesophagus and stomach, for example for cell changes in Barrett’s oesophagus, a lining altered by stomach acid flowing back.

First, fluid is injected beneath the lesion. This cushion lifts the lining away from the deeper muscle layer and creates distance from the rest of the bowel wall. A snare then encircles the lesion and cuts it off using high-frequency current – smaller ones in one piece, large ones usually in several. The edges are then cauterised; areas at risk of bleeding can be closed with small clips.

Every piece removed is examined in the laboratory. The report shows whether it was a benign precursor or an early tumour and, if it was removed in one piece, whether the margin is clear. If there is already a suspicion before the procedure that a tumour reaches deeper into the wall, other options come into consideration: submucosal dissection, in which the lesion is detached in one piece, or surgery.

The treatment

What EMR can achieve.

Preserve

Large polyps and early tumours of the mucosa are removed through the endoscope. This often makes it possible to avoid bowel surgery.

Clarify

The laboratory report shows exactly what was removed. It is the basis for every further decision.

Follow up

Follow-up endoscopies check the site where the lesion was removed. Small remnants that grow back can usually be removed endoscopically as well.

The path

From discovery to check-up.

The lesion is usually noticed during an endoscopy. The removal then often follows at a separate, well-prepared appointment.

  1. Assessment

    Size, location and shape are described and photographed. The pattern of the surface and blood vessels gives clues as to whether it is a benign precursor or an early tumour.

  2. Planning

    Together, you decide whether EMR is the right procedure. The consent discussion covers the procedure, risks and alternatives; blood-thinning medication is specifically planned for.

  3. Preparation

    A procedure in the bowel requires thorough cleansing; a procedure in the oesophagus or stomach requires an empty stomach. Treatment is usually carried out under sedation, an induced light sleep.

  4. Removal

    Injecting beneath the lesion, removing it, treating the edges – depending on the size, this takes longer than a simple endoscopy.

  5. Observation

    You are monitored afterwards, sometimes overnight after large removals. If you notice severe pain, fever or blood in your stool in the following days, get in touch immediately.

  6. Check-up

    If the lesion was removed in several pieces, the site is examined again after about six months and once more after a year and a half. All further intervals depend on the findings.

Insurance

Who covers the treatment.

Statutory health insurance

Medically necessary and therefore covered.

Removing a large polyp or early tumour is a medically necessary treatment. German statutory health insurance covers it, including the laboratory examination, follow-up endoscopies and, if necessary, the hospital stay.

In Wertheim, treatment covered by statutory insurance is provided by the Bürgerspital; a comfort room can be booked there on request as an optional extra, subject to availability.

Private insurance or self-pay

Your policy decides; both clinics are open to you.

For privately insured patients, reimbursement depends on their policy.

The Main-Tauber-Klinik, a private clinic in the Bürgerspital building, also treats privately insured and self-pay patients.

Specialists

Your doctors at a glance.

EMR is performed by the same gastroenterology team that carries out the preceding endoscopies. All three are specialists in internal medicine and gastroenterology.

  • Mamoon Al HamedSpecialist in Internal Medicine & GastroenterologyWertheim
  • Mohammad Al RashdanSpecialist in Internal Medicine & GastroenterologyWertheim
  • Dr. med. Barbara John, FEBGHSpecialist in Internal Medicine & GastroenterologyWertheim

Locations

Where treatment takes place.

Each clinic shows on its own website how the treatment works there.

Frequently asked questions

Good to know.

Why is a large polyp not removed straight away at the first endoscopy?

Sometimes it is. Large or flat lesions, however, require time, experience and suitable equipment. That is why they are often first assessed carefully and then removed at a separate appointment.

Will EMR spare me bowel surgery?

Often, yes. A large proportion of large, benign polyps can be removed completely by endoscopy, without losing any part of the bowel. If the laboratory finds a tumour with unfavourable features, surgery nevertheless remains the recommended next step.

What does it mean if the laboratory finds cancer cells?

Then the details matter: how deep the tumour reaches into the wall, how much the cells have changed, whether lymphatic vessels are affected and whether the resection margin is clear. If the features are favourable and everything has been removed, close monitoring is sufficient. Otherwise, surgery is recommended. The treatment team discusses the findings in detail.

Do I have to stay overnight?

That depends on the size and location of the lesion, on pre-existing conditions and on medication. Smaller removals are often possible as an outpatient; after large ones, some patients stay one night for observation.

What complications can EMR have?

The most common is bleeding, during the removal or up to a few days afterwards; it can usually be stopped endoscopically. Less often, a hole develops in the bowel wall. Depending on its size, it can be closed with clips during the procedure; otherwise surgery is needed. With large lesions, these risks are higher than with a simple polyp removal.

Can the polyp grow back?

After removal in several pieces, invisible remnants may remain and grow back. That is what the scheduled check-ups of the site are for. Small recurrences are usually removed endoscopically there and then.

What do I need to bear in mind before the procedure?

A complete list of your medication and a discussion about blood-thinning drugs are important. The bowel needs the same thorough cleansing as before any colonoscopy. Because treatment takes place under sedation, someone should accompany you home.

Consultation

Personal consultation.

Describe your request – the right clinic will get back to you.

CGCE Group in the media

  • ARD
  • Frankfurter Allgemeine Zeitung
  • WAZ
  • ProSieben
  • DIE WELT
  • Hamburger Abendblatt
  • SWR
  • Süddeutsche Zeitung
  • Stuttgarter Zeitung
  • FOCUS
  • Handelsblatt
  • Berliner Morgenpost
  • Galileo
  • BILD
  • Gala
  • Brigitte
  • Apotheken Umschau
  • Mannheimer Morgen
  • Bild der Frau
  • sonnenklar.TV
  • Main-Echo
  • Klassik Radio
  • Fränkische Nachrichten
  • Bild der Frau Schlank & fit
  • Radio Gong 96.3

Reviews

What patients say about us.

CGCE GroupVerified

5,888 reviews on ProvenExpert

  • Sithembiso F.

    This was the best decision I have ever taken for myself. The whole experience has changed my life for the better. From the first consultation I felt welcomed and treated very well. I did not feel alone during the journey because the team were just a WhatsApp away and they made regular check-ups on me. Thank you for everyone at the hospital from the staff to the doctors, you are all amazing.

    Weight Doctors South Africa
  • Maria

    Wow, was für ein erster Eindruck! Dr. Frank Gruner, dessen Professionalität von jahrelanger Erfahrung zeugt, war äußerst verständlich und menschlich (was mir sehr wichtig war). Er verstand meine Bedürfnisse, und seine Erklärungen und Anweisungen entsprachen genau meinen Vorstellungen. Die Patientenberaterin Jennifer war mit ihrem Charme ebenfalls eine große Hilfe und erklärte mir alles Notwendige und den weiteren Ablauf. Auch die Mitarbeiter am Empfang waren sehr höflich und freundlich. Ich melde mich nach der Operation mit meinen Eindrücken zurück. Vielen Dank an alle!

    Westfalenklinik Fachklinik für Plastische und Ästhetische Chirurgie · Original in German
  • Anonym

    Ich habe eine Unterlidstraffung machen lassen und bin mit dem Ergebnis sehr zufrieden. Mein Dank geht vor allem an Frau Dr. Simidjiiska für ihre Fürsorge, Kompetenz und Empathie. Aber auch das gesamte Team der Klinik macht einen hervorragenden Job!

    Westfalenklinik Fachklinik für Plastische und Ästhetische Chirurgie · Original in German
  • Anonym

    Ich bin rundum begeistert von meiner Erfahrung in dieser Haartransplantationsklinik. Von der ersten Kontaktaufnahme bis zur Nachsorge war alles hervorragend organisiert und professionell. Das gesamte Team war unglaublich freundlich, hilfsbereit und zuvorkommend. Man hat sich jederzeit gut aufgehoben und ernst genommen gefühlt. Besonders positiv fand ich, dass sich alle Mitarbeiter ausreichend Zeit genommen haben, um meine Fragen zu beantworten und jeden Schritt verständlich zu erklären. Auch der Service war erstklassig. Die Organisation, die Betreuung vor und nach dem Eingriff sowie die Kommunikation waren wirklich hervorragend. Das gesamte Team hat einen sehr kompetenten und gleichzeitig menschlichen Eindruck gemacht. Die Klinik selbst ist modern, sauber und sehr gut ausgestattet. Während der Behandlung wurde äußerst sorgfältig und professionell gearbeitet, und ich hatte zu jedem Zeitpunkt das Gefühl, in guten Händen zu sein. Ein großes Dankeschön an das gesamte Team für die tolle Betreuung und den freundlichen Umgang! Ich kann die Klinik absolut weiterempfehlen und bin mit meiner bisherigen Erfahrung sehr zufrieden. Wer Wert auf Professionalität, Qualität und einen hervorragenden Service legt, ist hier meiner Meinung nach bestens aufgehoben.

    Westfalenklinik Fachklinik für Plastische und Ästhetische Chirurgie · Original in German
  • Andre W.

    Bisher war es nur ein Beratungsgespräch aber es war sehr gut.

    Weight Doctors Group · Original in German
  • David C.

    Ich fand, dass der Arzt gut und verständlich erklärt hat. Ich habe diese Woche noch einen Termin in einer anderen Klinik, da ich mich gründlich informieren möchte; auch der Preis wird dabei eine Rolle spielen – darüber bin ich ganz offen.

    QUOLE Medisch Centrum · Original in German
  • Momo

    Hervorragende Behandlung. Von der ersten Beratung bis zur Nachsorge hat mir Dr. Koch stets ein sehr gutes Gefühl vermittelt. Ich litt jahrelang unter einer echten Gynäkomastie, nach der OP kann sich das Ergebnis sehen lassen, mein Selbstbewusstsein ist endlich zurückgekehrt. Ich kann die Alster Klinik jedem empfehlen, der schon lange mit dem Gedanken spielt sich operieren zu lassen.

    Alster-Klinik Hamburg · Original in German
  • Anonym

    Dr. Schubert gab mir das Gefühl, in genau der richtigen Praxis zu sein für mein Anliegen. Ich habe mich beim Beratungsgespräch sehr wohl gefühlt und verstanden gefühlt.

    Alster-Klinik Hamburg · Original in German
  • Lieselotte S.

    Über die ehrliche Einschätzung

    Alster-Klinik Hamburg · Original in German
  • Hannelore G.

    Ich habe mich sehr wohl geführt, das Gespräch war sehr gut, die Ärztin hat mir sehr ausführlich alles erklärt und bin mit einem sehr guten Gefühl nach Hause gegangen.

    Westfalenklinik Fachklinik für Plastische und Ästhetische Chirurgie · Original in German
  • Carmen K.

    Ich bin eine sehr ängstliche Person. Bei Herrn Dr. Neis habe ich mich sofort wohlgefühlt. Behandlungsgespräche, Umgang, Freundlichkeit – es passt alles. Ich kann ihn ohne Bedenken und Einschränkung nur weiter empfehlen. Dankeschön Herr Dr. Neis für die tolle Arbeit.

    CGCE Group · Original in German
  • Michaela L.

    Dr. Klarner ist sehr nett, hat mich sehr gut beraten und aufgeklärt. Ich hab mich gut aufgehoben gefühlt, vielen Dank!

    Alster-Klinik Hamburg · Original in German

12 brands at 23 locations in six countries

Which location is closest to you?

Bookappointment