ESD (Endoscopic Submucosal Dissection)


Endoscopic submucosal dissection (ESD) is a technique for the removal of deep-seated lesions or lesions larger than 1 cm. It is generally used for the removal of large tumors with superficial invasion or deeply located lesions. With this method, the borders of the lesion are first identified and marked. Then a special substance is injected into the base of the lesion, inflating it and creating a cushion. Afterwards, an endoscope and special equipment are inserted between the lesion and normal tissue and the lesioned part is removed from the normal tissue by making a slow incision under the lesion. This usually leaves a large opening, which is closed using endoscopic sutures in some cases, depending on the lesion.

Increasingly used to replace traditional Endoscopic Mucosal Resection (EMR) techniques, ESD allows many patients to be treated without the need for surgery. This method allows lesions to be removed in one piece, thus providing a more accurate histologic evaluation and helping patients to recover faster.

How is ESD Process Performed?

During the ESD procedure, the perimeter of the lesion is first marked with an electrocautery (a device for cutting or burning tissue using electrical energy). Then, using an electrocautery or similar instrument, the perimeter of the lesion is cut and the mucosal layer is removed. The submucosal layer at the base of the lesion is inflated by injecting a special fluid, which separates the lesion from the healthy tissue. Finally, the lesion is completely removed from the submucosal layer.

Who is it suitable for?

ESD is generally preferred in the early stages of non-invasive gastrointestinal cancers (for example, gastric cancer or colorectal cancer) and larger benign lesions (for example, adenomatous polyps).

What are the Risks of ESD Procedure?

ESD is a procedure that has a risk of bleeding and perforation and must be performed by experienced hands. Although it is a method used especially in risky and difficult to remove lesions and involves various risks due to the fact that the procedure is performed by going deep into the tissue, many patients regain their health with this method without the need for surgery.

Post Implementation Process

Patients are usually discharged the same day after the procedure. However, for procedures performed on large and risky lesions, an overnight hospital stay may rarely be required for follow-up.

What should be considered after the procedure?

Especially in esophageal and gastric procedures, it is recommended not to take food by mouth for a while and to start taking food with a liquid diet. However, the transition to nutrition should be evaluated on the basis of each patient and the procedure performed. Information about follow-up and starting food intake after the procedure will be communicated to the patient by the doctor. In case of bleeding and severe pain after the procedure, it is absolutely necessary to consult a doctor.

Endoscopic Submucosal Dissection (ESD) is a breakthrough method in the treatment of non-invasive early stage gastrointestinal cancers and removal of large benign lesions. This technique provides more accurate histologic evaluations with faster recovery times and less risk of complications. However, ESD is complex to perform and should be performed by an experienced endoscopist. Therefore, if you are considering this type of procedure, it is important to consult with a gastroenterologist to determine the best option for you.