If there is a tumor or early lesion in the mucosa of the digestive tract, the doctor may recommend removing it with a procedure called endoscopic submucosal dissection (ESD).

What is endoscopic submucosal dissection (ESD)?
Endoscopic submucosal dissection (ESD) is a minimally invasive therapeutic procedure to remove large polyps or early cancer lesions in the digestive tract using an endoscope. The term “submucosal dissection” means that this procedure is performed by cutting the submucosal area to obtain a specimen of the mucosal lesion.

Figure 1. Steps in the ESD procedure
(Source: Lambin T, et al., 2021)

ESD is an endoscopic technique performed by injecting a solution into the submucosal layer, followed by dissection around and beneath the lesion, with the separation of the submucosal layer using an electrocautery knife. The ESD technique allows endoscopists to visualize and control the depth of dissection. ESD provides the ability to remove large superficial tumors in one piece.

Steps in the ESD Procedure:
a. Marking the lesion.
b. Submucosal injection.
c. Circumferential mucosal incision (original techniques).
d. Submucosal dissection.

Who might need ESD?
The ESD procedure can be used to treat early-stage tumors and lesions:
– Early-stage cancer or polyps in the intestine, including colorectal cancer, stomach cancer, and esophageal cancer.
– Tumors in the esophagus, stomach, or intestines that have not penetrated deeper layers of the digestive tract wall.

ESD in such cases can help minimize the risk of cancer spreading. ESD can also aid in determining the stage of digestive tract cancer (determining its spread) to subsequently determine an appropriate treatment plan.

Preparation for ESD
Preparations that may be done before undergoing the ESD procedure include:
– For upper digestive tract procedures: fasting for 12 hours before the procedure to ensure the upper digestive tract is free of food.
– For lower digestive tract procedures: following a liquid diet along with laxatives or enema to cleanse the intestines.

After the ESD procedure is performed, the patient will be monitored in the recovery room while waiting for the sedative effects to wear off. During recovery, the patient may experience a sore throat, nausea or vomiting, and bloating. Meanwhile, complications such as bleeding and perforation are rare events.

*The information in this article has been reviewed by Dr. Rabbinu Rangga Pribadi (Consultant Gastroenterohepatologist).

Cover ilustration:
Getty images
  1. Harlow C, Sivananthan A, Ayaru L, Patel K, Darzi A, Patel N. Endoscopic submucosal dissection: an update on tools and accessories. Ther Adv Gastrointest Endosc. 2020 Sep 28;13:2631774520957220. doi: 10.1177/2631774520957220. PMID: 33089213; PMCID: PMC7545765.
  2. Lambin T, Rivory J, Wallenhorst T, Legros R, Monzy F, Jacques J, Pioche M. Endoscopic submucosal dissection: How to be more efficient? Endosc Int Open. 2021 Nov 12;9(11):E1720-E1730. doi: 10.1055/a-1554-3884. PMID: 34790536; PMCID: PMC8589544.
  3. Nagar, A.B. (2017). Endoscopic Submucosal Dissection. In: Romanelli, J., Desilets, D., Earle, D. (eds) NOTES and Endoluminal Surgery. Clinical Gastroenterology. Springer, Cham. https://doi.org/10.1007/978-3-319-50610-4_4
  4. Johns Hopkins Medicine. Endoscopic Submucosal Dissection. Retrivied from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/endoscopic-submucosal-dissection


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