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Endoscopic Submucosal Dissection

What is Endoscopic Submucosal Dissection (ESD)?

Endoscopic submucosal dissection is an advanced surgical procedure performed with the help of an endoscope, a flexible tube-like device with a light source and camera, to remove gastrointestinal tumours that are underneath the mucosal layer but have not entered the muscle layer. ESD procedures may be conducted in the oesophagus, stomach, or colon.

Indication for Endoscopic Submucosal Dissection

Some of the indications for endoscopic submucosal dissection include:

  • Barrett’s oesophagus
  • Early-stage colon polyps or cancerous tumours
  • Premalignant and early-stage malignant lesions of the stomach, colorectum or oesophagus

Preparation for endoscopic Submucosal Dissection

  • You should inform your doctor of any medications, vitamins, or supplements that you are taking.
  • Inform your doctor if you are allergic to any medication or anaesthesia.
  • Follow a liquid diet plus a laxative or enema in order to cleanse the bowel.
  • Avoid food and drink for several hours before the procedure.
  • Arrange for someone to drive you back home after the procedure.

Endoscopic Submucosal Dissection Procedure

  • The procedure is performed under general anaesthesia.
  • The doctor will insert an endoscope into your mouth or anus depending on the location of the tumour. The endoscope will provide internal images which can be viewed on a screen.
  • A special stain or dye will be used to highlight the cancerous regions to segregate them from healthy tissues.
  • The layer beneath the mucosa (submucosa) will be injected with a solution to lift it away from the muscle wall. This is done to minimize the damage to the surrounding tissue layers during the procedure.
  • An electrosurgical knife with a high-frequency electrical current will be used to remove the tumour tissue from the gastrointestinal wall. The electric current helps to stop any active bleeding.
  • The tissue will be removed from the body through the endoscope. 

Postoperative Care after Endoscopic Submucosal Dissection

After the procedure, you will need to spend a few hours in the recovery room under observation. The procedure can be conducted as an outpatient treatment. You can drink again after the numbness in your throat goes away. You can resume eating the next day following the surgery.

Risks and Complications of Endoscopic Submucosal Dissection

Some of the risks and complications for endoscopic submucosal dissection include:

  • Sore throat
  • Nausea or vomiting
  • Excessive gas, bloating, or cramping
  • Bleeding
  • Oesophagal stricture
  • Tearing of the oesophagus or stomach 

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