Endoscopic Mucosectomy in Madrid
Advanced endoscopy specialist with underwater technique. Minimally invasive treatment of polyps and premalignant lesions of the digestive tract.
Advanced Endoscopist - INMEQ | Hospital Universitario La Paz
What is an endoscopic mucosectomy?
As a specialist in advanced endoscopy, one of the techniques I perform most frequently for treating premalignant lesions of the digestive tract is endoscopic mucosectomy or EMR (Endoscopic Mucosal Resection). This minimally invasive technique allows the removal of superficial lesions from the digestive tract without the need for surgery.
Mucosectomy is a therapeutic endoscopic technique that involves the controlled resection of the mucosal layer of the digestive tract—that is, the internal lining where most premalignant and early malignant tumors originate. It is especially useful for flat polyps, adenomas, and dysplastic lesions located in the colon, rectum, esophagus, or stomach.
Why do I perform the underwater technique?
Specialized technique with superior advantages
Although there are several technical variants of mucosectomy, in my practice I preferentially use the underwater technique. This involves filling the intestinal segment with water, avoiding the insufflation of air or CO₂, and facilitating resection without the need for prior submucosal injection.
Key advantages of the underwater technique:
Greater safety
By avoiding air, the intestinal wall is less distended, reducing the risk of perforation.
Better resection rates
By floating the mucosa, complete resection of the lesion in one piece is facilitated.
Clearer visualization
The liquid medium improves visibility of margins and vessels, allowing more precise resection.
More efficient procedures
Shorter procedure times in many cases.
Validated technique: This technique was initially described by Binmoeller in 2012, and since then has demonstrated excellent results in safety and efficacy, especially in right colon and distal rectum lesions.
Common indications in my practice
How is underwater mucosectomy performed?
The colonoscope is introduced to the area of the lesion.
Instead of insufflating air, the colon lumen is filled with water.
The lesion unfolds and naturally separates from the muscularis propria without the need for injection.
A resection snare is used to cut the lesion en bloc or in fragments (piecemeal), depending on size and location.
If necessary, hemostatic clips are placed to close the mucosal defect and prevent bleeding.
Safety and recovery
Outpatient
Outpatient procedure in most cases
Quick recovery
Normal activity in 24-48 hours
Low morbidity
Complications less than 1%
Complications are infrequent and usually mild (self-limited bleeding or mild abdominal distention). In experienced hands, the rate of major complications such as perforation is less than 1%.
My experience in underwater mucosectomy
Since I introduced this technique into my practice, I have been able to perform hundreds of safe and effective resections in patients with lesions that, in another context, might have required surgery.
Reference centers:
- Hospital San Rafael (Madrid)
- Hospital Fuensanta (Madrid)
- Hospital Universitario La Paz
Recognition:
- European Advisor Olympus
- TopDoctors Award
- IMEQ Co-founder
When is this technique indicated?
If you have been diagnosed with a flat polyp, suspicious lesion in the colon or duodenum, underwater mucosectomy can be a safe and effective alternative to traditional surgery.
I always perform an individualized assessment, supported by advanced imaging techniques (NBI, digital chromoendoscopy) to determine the best therapeutic strategy in each case.
Dr. Pedro de María Pallarés
Digestive System and Advanced Endoscopy Specialist
Hospital Universitario La Paz – IMEQ Co-founder