Endoscopic multi-band mucosal resection (MBMR) is a technique using specialized endoscopic technology to remove large areas of abnormal gastrointestinal mucosa that are difficult to remove through standard biopsies or other techniques. MBMR is used to excise abnormal growths in the esophagus, stomach and colon.
For the upper intestinal tract, the technique is as follows:
The patient is sedated as in a standard endoscopy. As the technique takes significantly longer than standard endoscopy, it requires larger amounts of medication and a longer monitoring period.
An endoscope is passed into the esophagus and stomach to confirm the location of the abnormal area which will be endoscopically removed. Once the area has been visually identified, an endoscopic thermal probe such as a Bicap is passed and the abnormal area is “outlined” with electro coagulation contact marks around the abnormal tissue.
After removing the scope, the physician then inserts the MBMR scope, with the proper device attached to it, and carefully identifies the abnormal area.
Using suction, the physician draws the abnormal mucosa into the plastic cap section of the MBMR device. A band is then deployed around the tissue, creating a polyp of tissue. A snare then encircles the polyp and, using coagulation with the possible need of additional cutting current, removes the polyp. The polyp is then gathered into the MBMR cap by suction, and the scope and specimen are removed.
This process is then repeated with reintroduction of the MBMR scope, using suction and applying an additional band, followed by resection of the tissue.
This technique can be repeated approximately five times per MBMR device. It allows us to remove large amounts of the mucosal surface safely and effectively, without resorting to surgical esophagectomy. The large specimens obtained also significantly improve our ability to examine tissue changes, allowing us to plan for the patient’s individual therapy in a much more accurate way.
A special MBMR kit is required for this at a cost of $150. Two endoscopes are needed for each case. The procedure also requires a coagulation probe, specialized snare, electrosurgical generator and grounding pads. If multiple specimens are obtained, a Roth basket is required for collection of the specimens. In addition to the physician, two nurses are present during the entire procedure for assistance. Anesthesia personnel are also required. The duration of MBMR typically is 45to 60 minutes per treatment.