Concierge gastroenterology · UK
Endoscopic mucosal resection in the UK, by a therapeutic endoscopist.
A modern, no-incision alternative to surgery for superficial polyps, dysplasia and early cancers of the gut lining - done by consultants who do a lot of them, in centres set up for it, with ESD offered when it is the better call.
Why patients choose us
- 01
A therapeutic-endoscopy consultant, not a list-filler
Endoscopic mucosal resection is a specialist skill. We route you to consultants who do a high volume of EMR (and, where appropriate, ESD) - not to whoever has the next slot.
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ESD on the table when it should be
For larger lesions and early cancers, en-bloc endoscopic submucosal dissection may be the better call. We name the UK centres that do it and say when it applies.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What EMR (and ESD) actually cost privately in the UK.
Indicative ranges across our partner centres. Send the endoscopy or histology report and we quote firm figures across two or three options.
In short
Colonic EMR in our network: £3,000–£5,500, home the same day.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| Diagnostic gastroscopy or colonoscopy (planning) | £1,200–£2,200 | 30–45 min | Same visit |
| EMR - colonic polyp / LST | £3,000–£5,500 | 45–90 min | Same day |
| EMR - oesophageal (Barrett’s dysplasia) | £3,500–£6,000 | 45–75 min | Same day |
| EMR - gastric or duodenal adenoma | £3,500–£6,000 | 45–90 min | Same day |
| Endoscopic submucosal dissection (ESD) | £6,000–£10,000 | 90–180 min | 0–1 night |
| Consultation only | £250–£450 | 30 min | Same visit |
Prices vary by centre, by which endoscopist does the case, by the anaesthetic chosen, and by whether the lesion turns out larger than expected on the day. EMR is also routinely available on the NHS via gastroenterology - we can help you weigh both routes honestly.
The problem
The right endoscopist, the right technique, the right centre.
EMR is a specialist-endoscopist skill. Done well it avoids an operation; done poorly it leaves residual disease or turns a manageable lesion into a bowel resection. The three things worth getting right are the operator, the technique and the follow-up.
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Not sure it needs surgery?
Many large polyps, Barrett’s lesions and even some early cancers are best removed endoscopically. We say so before you agree to a bowel operation.
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Should this be ESD, not EMR?
For lesions over about 20 mm - especially with a cancer question - en-bloc ESD gives cleaner margins. We name the UK centres that do it well.
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Want the surveillance right?
Recurrence lives or dies on the 3–6 month check. We book it, track the histology and escalate if the margin is involved.
The journey
From enquiry to surveillance - what happens, in order.
One clinician from first message to the 3–6 month check - including the histology and any re-treatment.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
A few hours at the centre
Phase 3 · After
Concierge, back on
- 01
Before
You send us the report
Colonoscopy, gastroscopy or histology report - plus any images. A short, confidential form covers the rest.
- 02
Before
We come back with a plan
Within one working day: EMR, ESD or straight to surgery - with the right endoscopist, the right centre and an indicative price.
- 03
Before
We arrange the procedure
Usually within one to three weeks. Aspirin, clopidogrel, DOACs and warfarin are reviewed with the team and you are told exactly how to prepare.
- 04
On the day
Arrival and consent
A quiet admission, consent with the endoscopist and anaesthetist, and bowel-prep or fasting check. Sedation or GA - whichever fits the case.
- 05
On the day
The resection
30 to 90 minutes. Submucosal injection lifts the lesion, a snare removes it, the base is cauterised and any residual is treated with argon plasma coagulation.
- 06
On the day
Home the same day
A short recovery, written aftercare and home within a few hours. With sedation you will need someone to collect you.
- 07
After
Histology and surveillance
The specimen goes to pathology. We track the result and book the 3–6 month surveillance endoscopy, or escalate if margins are involved.
Typical end-to-end: 2–3 weeks from enquiry to procedure. Surveillance check: 3–6 months.
When it helps
When endoscopic mucosal resection is the right step.
The situations we see most, from Barrett’s dysplasia to laterally-spreading polyps - plus the red flag that means a surgical operation rather than an endoscopy.
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Barrett’s oesophagus with dysplasia
Low- or high-grade dysplasia on Barrett’s biopsies - EMR of visible lesions, usually combined with radiofrequency ablation.
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Superficial oesophageal cancer (T1a)
Intramucosal squamous or adenocarcinoma limited to the mucosa - endoscopic resection can be curative in well-selected cases.
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Gastric adenoma or early gastric cancer
Gastric adenoma, high-grade dysplasia, or T1a mucosal cancer without lymphovascular invasion.
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Duodenal or ampullary adenoma
Sporadic non-ampullary duodenal adenoma, or an ampullary adenoma removed by endoscopic ampullectomy.
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Large sessile colonic polyps / LSTs
Sessile or laterally-spreading tumours over 20 mm that are not amenable to standard snare polypectomy.
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Rectal LSTs and superficial rectal cancer
Rectal laterally-spreading tumours and mucosal cancers - EMR, ESD or TAMIS depending on size and depth.
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T1a colorectal cancer, favourable features
Cancer limited to the mucosa, well-differentiated and with no lymphatic invasion - a small, well-defined group where endoscopy avoids surgery.
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Red flag: deep invasion or nodes
Submucosal invasion, poor differentiation, lymphovascular invasion or suspicious nodes on staging - this is a surgical problem, not an endoscopic one.
Technique options
EMR is not one technique - and ESD is on the table too.
What each variant actually involves - and which fits which lesion, from a short-segment Barrett’s island to a 40 mm colonic LST.
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Conventional injection-assisted EMR
Saline with adrenaline and methylene blue (or hyaluronic acid, glycerol) lifts the mucosa off muscularis, then a diathermy snare removes the lesion.
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En-bloc EMR (single piece)
Preferred for lesions up to about 20 mm - one clean specimen gives the pathologist proper margins and lower recurrence.
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Piecemeal EMR
Used for larger lesions removed in fragments. Effective, but recurrence is higher (15–25%) and cancer margins are harder to assess.
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EMR-C (cap-assisted)
A clear plastic cap on the scope suctions the lesion into a pre-loaded snare - used in the oesophagus and stomach.
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EMR-L (ligation-assisted)
A variceal-band ligator creates a pseudopolyp, then a snare removes it - a workhorse for short-segment Barrett’s dysplasia.
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Underwater EMR
A newer technique - the lumen is filled with water rather than injecting a cushion. Useful for select colonic and duodenal lesions.
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Argon plasma coagulation (APC)
Ablates small residual islands or satellite lesions at the resection margin, and is a mainstay of the Barrett’s treatment package.
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ESD (endoscopic submucosal dissection)
For larger lesions and early cancer, ESD removes the lesion en-bloc regardless of size - a longer, more specialist procedure available at a growing list of UK centres.
Our vetted UK network
A small panel of therapeutic endoscopists, we picked them.
Consultants across the London teaching centres and the main regional ESD units - St Mark’s, UCLH, GSTT, Kings, Nottingham, Manchester, Newcastle, Bristol and Portsmouth. Not listed publicly - introductions are made privately, once we understand the case.
Selection criteria
How we choose every endoscopist in our network.
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Consultant therapeutic endoscopists with a high-volume EMR practice
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ESD available at named UK centres (St Mark’s, UCLH, GSTT, Kings, Nottingham, Manchester, Newcastle, Bristol, Portsmouth)
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Multi-disciplinary team review for any lesion with a cancer question
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Anaesthetist-supported sedation or GA for longer resections
Safety and recovery
What to expect afterwards - honestly.
EMR has an excellent technical success rate - over 95% in expert hands - but it is not risk-free. Bleeding, perforation and incomplete resection are the three worth planning for.
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Bleeding is the commonest problem
Immediate or delayed bleeding (1–14 days after) affects 5–15% of cases - usually controlled endoscopically with clips, adrenaline injection or APC.
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Perforation is uncommon but real
Full-thickness perforation happens in 1–3%. Small defects can often be closed endoscopically with clips; larger ones may need surgery.
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Post-polypectomy syndrome
Abdominal pain and low-grade fever from a serosal burn - no perforation on imaging. Usually settles with antibiotics and rest.
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Incomplete resection can happen
Especially with piecemeal EMR of large lesions. A planned 3–6 month check picks up residual disease and re-treats endoscopically.
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Blood or mucus for 24–48 hours
Some blood or mucus in the stool for a day or two is expected - heavy fresh bleeding or clots is not, and needs same-day advice.
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Stop and restart blood thinners carefully
Aspirin, clopidogrel, DOACs and warfarin are paused per bleeding risk - usually 5–7 days - and restarted on the endoscopist’s instruction, not on your own.
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No heavy lifting or gym for 1–2 weeks
Walking and desk work are fine within a few days. Cycling, running, weights and long-haul flights wait until the endoscopist clears you.
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Oesophageal stricture - a specific risk
Circumferential or long oesophageal EMR can scar down and narrow the gullet. Planned dilatation is sometimes needed and is factored into consent.
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Red flags after discharge
Severe abdominal pain, a hard swollen abdomen, fever, black tarry stool or heavy fresh bleeding - call the unit or A&E the same day.
Reading your procedure note
Your EMR note in four parts. Read the last one first.
Whichever technique was used, the note the endoscopist sends you keeps to the same shape.
A quiet reminder
Endoscopic language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Lesion, site and Paris classification
Where the lesion was, its size in millimetres, and how it looked - Paris 0-IIa, 0-Is, LST-G, LST-NG - plus the Kudo pit pattern or JNET class if used.
- 02 Technique
Injection, snare and any APC
The lifting solution used, whether resection was en-bloc or piecemeal, the number of pieces, and whether the base was treated with clips or argon plasma coagulation.
- 03 Findings
Completeness, defect closure and photos
Notes on completeness of resection, whether the defect was closed with clips, and any adverse events during the procedure.
- 04 Impression
Histology plan and surveillance interval
Read this first: what the pathologist is being asked, when the next endoscopy is planned (usually 3–6 months) and what would trigger a change of plan.
Recognised by major UK insurers
Cover for EMR and ESD varies by insurer and by indication - usually funded when the lesion is clinically significant. We confirm cover before booking.
Frequently asked
Everything we get asked about endoscopic mucosal resection.
Quick answers on EMR versus ESD, when it can replace surgery, cost, recovery, and how the surveillance actually works.
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What is endoscopic mucosal resection (EMR)?
EMR is a technique for removing superficial lesions of the gut lining - polyps, dysplasia and very early cancers - through a gastroscope or colonoscope. A saline cushion is injected under the lesion to lift it off the muscle layer, then a wire snare cuts it away with cautery. No cut on the skin, no bowel removed.
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How is EMR different from ESD?
EMR captures the lesion in a snare and works best up to about 20 mm en-bloc, or in pieces for larger lesions. ESD dissects the lesion off the submucosa in one piece regardless of size - better margins for cancer, but longer, more technically demanding and available at fewer UK centres. For a large lesion or a lesion with a cancer question, ESD is often the better call.
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When is EMR the right treatment for a colon polyp?
Large sessile or laterally-spreading polyps over 20 mm that are not amenable to standard snare polypectomy, sessile adenomas with high-grade dysplasia, and select T1a colorectal cancers that are limited to the mucosa, well-differentiated and free of lymphatic invasion.
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What does EMR cost privately in the UK?
Roughly £3,000–£5,500 for a colonic EMR, £3,500–£6,000 for oesophageal, gastric or duodenal EMR, and £6,000–£10,000 for endoscopic submucosal dissection. Prices depend on the endoscopist, the centre, the anaesthetic and the length of the case.
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Is EMR painful and how long is the recovery?
You feel nothing during the procedure - it is done under sedation or, for longer cases, general anaesthetic. Afterwards there is usually mild abdominal cramping and some blood or mucus in the stool for a day or two. Most people are back to office work within one to three days and to the gym after one to two weeks.
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What are the risks of EMR?
Bleeding (5–15%, usually stopped endoscopically), perforation (1–3%, often closed with clips), post-polypectomy syndrome (a serosal burn causing pain and low-grade fever), incomplete resection and, for piecemeal cases, missed cancer at the margin. Oesophageal EMR can scar and narrow the gullet.
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What happens after EMR - how is it followed up?
The specimen goes to pathology and the result guides everything. A repeat endoscopy is booked at 3–6 months to check for recurrence - recurrence rates run at 3–5% for en-bloc EMR and 15–25% for piecemeal. Most recurrences are picked up and re-treated endoscopically.
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Can EMR replace surgery for early cancer?
In carefully selected cases, yes. For T1a intramucosal cancer with favourable features - well-differentiated, no lymphovascular invasion, clear margins - endoscopic resection is curative and avoids a bowel or oesophageal operation. If the pathologist finds submucosal invasion or unfavourable features, surgery is added.
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All tests & procedures
Every test and procedure we arrange.
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