What is ESD (endoscopic submucosal dissection) and why is it performed?

Endoscopic Submucosal Dissection (ESD) is a sophisticated, minimally invasive medical procedure primarily used to remove cancerous or potentially cancerous lesions from the gastrointestinal tract. This includes areas like the oesophagus, stomach, and colon.

The technique allows for the removal of larger lesions in one piece, which is beneficial for both accurate diagnosis and treatment. ESD is the preferred treatment for early oesophageal, gastric and colonic cancer as it has similar clinical outcomes to surgery with considerable less risk and long term complications.

A/Prof Marios Efthymiou has expertise in ESD in the oesophagus, stomach and colon.

What preparations are required?

Dependent on the location of the lesion that is to be treated, the preparatory instructions for gastroscopy or colonoscopy will need to be followed. Some medications may need to be discontinued before ESD, including aspirin, clopidogrel or warfarin. Before discontinuing any of these medications you must consult your Doctor.

What happens during ESD?

Your doctor will first discuss the risks of the procedure with you and address any questions you may have. You will then meet your anaesthetist who will discuss all aspects of the anaesthetic. Following this you will be taken to the procedure room. You'll then lie on your side, and a needle will be placed in your hand or arm. This is used to administer the anaesthetic.

ESD is performed under general anaesthetic. Once you are completely asleep your doctor will pass the endoscope through your mouth or the anus dependent on the location of the lesion to be treated. The doctor injects a solution beneath the lesion to lift it away from the muscle layer. Specialised instruments are then used to carefully dissect and remove the lesion. The procedure duration is variable dependent on the size of the size and complexity of the lesion.

What happens after ESD?

You will be admitted to hospital overnight for observation and likely to remain fasting for at least 4 hours. If you feel well and there are no concerns after the procedure, clear fluids maybe commenced on the same day. Your Doctor will provide some advice regarding recommencing your usual medications. Provided you are well overnight, you will commence a light breakfast the following morning and will be discharged.

What are the possible complications of ESD?

Although complications after EMR are uncommon, it's important to recognise complications and treat them early.

Bleeding: Minor bleeding may occur during or after the procedure. In most cases, it can be controlled endoscopically. Bleeding can occur up to two weeks after the procedure.

Perforation: There's a small risk of creating a hole in the wall of the gastrointestinal tract, most of the time this is able to be repaired endoscopically, very rarely surgery maybe required.

Infection: Infections are rare but can occur, particularly if there's a perforation.

Post-ESD Syndrome: Some patients may experience pain, fever, or discomfort, often due to inflammation at the site of the resection.

Stricture Formation: In cases where a large area is treated, especially in the oesophagus, narrowing (stricture) may occur, potentially requiring further treatment.

Contact your doctor immediately if you have a fever after the test or if you notice trouble swallowing or increasing throat, chest or abdominal pain, or bleeding, including black stools. If you have any concerns following your test, you should contact your doctor right away.