Subspecializing in gastrointestinal tract cancers, including the stomach, pancreas, liver, large and small intestine, spleen, anus/rectum, gallbladder and peritoneal cavity.
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Endoscopic Submucosal Dissection
Endoscopic submucosal dissection (ESD) is revolutionary, incisionless, minimally invasive advanced endoscopic procedure designed to remove gastrointestinal tumors while preserving the native organ. By utilizing this method, patients can benefit from reduced recovery times, better quality of life and improved outcomes, making it a valuable option in the management of gastrointestinal tumors.
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What Is Endoscopic Submucosal Dissection?
ESD is an advanced endoscopic technique that allows for en-bloc resection of lesions that would otherwise require surgery. Unlike traditional endoscopic resection methods that are limited to removing smaller polyps, ESD enables deep and complete removal of large or high-risk lesions.
ESD follows a structured, highly precise process to ensure selection of the appropriate lesion and successful tumor removal.
Step 1: Pre-Procedure Evaluation
Before the procedure, patients undergo a thorough evaluation. This may include endoscopy with high-definition imaging and magnification, and endoscopic ultrasound for appropriate staging of the lesion. Other tests like CT scans, MRIs or PET scan may be required as well. While ESD is designed for removal of early GI cancers, more advanced cancers will always require surgical for curative resection.
Step 2: ESD Procedure
The procedure is performed using an endoscope (flexible camera with a light) that is introduced either through the mouth or the anus depending on the location of the lesion in the GI tract.
The procedure involves using a needle to inject a specialized fluid beneath the lesion to lift it from the deeper layers of the gastrointestinal wall, creating a safe working space. Various endoscopic knives (flexible tools that can be introduced through the working channel of the endoscope, designed to cut and cauterize the GI tissue) are then used to cut the lesion and dissect it from the underlying layers.
During that dissection process -since we are dissecting through living tissue- minimal bleeding is expected and is controlled with other flexible tools introduced through the endoscope that includes endoscopic coagulation graspers, endoscopic clips and endoscopic hemostatic gels.
The process continues until the lesion is finally separated from the underlying GI wall layers. The lesion is then retrieved using retrieval devices like a flexible endoscopic net that can be introduced through the endoscope to retrieve the dissected tissue.
The tissue is then placed in a special container and sent to the pathology lab for testing to obtain a final diagnosis and staging of the cancer to determine if the resection is curative or not.
Step 3: Post-procedure:
Patients are typically observed overnight in the hospital and released next morning.
Endoscopic submucosal dissection (ESD) is effective for various gastrointestinal conditions. It allows for the removal of tumors while preserving surrounding healthy tissue. Key conditions treated with ESD include:
Colorectal Neoplasms
- ESD is used to remove polyps and early-stage cancers in the colon and rectum.
Gastric Neoplasms
- ESD effectively treats early gastric cancers and benign tumors in the stomach.
- It minimizes the need for more invasive surgical options.
Esophageal Cancer and Barrett’s Esophagus
- ESD is beneficial for early-stage esophageal cancer and pre-cancerous Barrett’s esophagus related lesions, allowing for complete resection.
- Sparing the patient partial or complete removal of the esophagus that helps maintain esophageal function and quality of life.
Rectal Tumors
- ESD can remove rectal tumors that are not amenable to traditional endoscopic techniques.
By utilizing ESD, healthcare providers can offer patients a minimally invasive option for treating these conditions, leading to better outcomes and preservation of gastrointestinal function.
Endoscopic submucosal dissection (ESD) offers several advantages over traditional surgical methods.
Minimally Invasive Approach
- ESD requires no skin incisions, reduces recovery time and discomfort.
- Patients often experience less pain compared to open surgery.
Curative Resection
- ESD is effective for early-stage cancers and precancerous lesions.
- Enables complete removal, potentially eliminating the need for further treatment.
Preservation of Digestive Tract Function
- By maintaining the integrity of the gastrointestinal tract, ESD helps preserve normal digestive function.
- Patients can often return to their regular diets sooner than with surgery.
Shorter Hospital Stay
- Many patients can go home the same day or after a brief observation period.
- This leads to lower healthcare costs and less disruption to daily life.
Endoscopic submucosal dissection (ESD) carries potential risks that patients should be aware of before undergoing the procedure. While ESD is generally safe, complications can occur, including:
Bleeding
- Bleeding may happen during or after the procedure.
- It can often be controlled with hemostatic techniques, but in some cases, additional interventions may be necessary.
Gastrointestinal Perforation
- There is a risk of perforating the gastrointestinal wall during dissection.
- This complication may require surgical intervention to repair or even organ resection.
Incomplete Resection
For various reasons related to the cancer being treated or technical issues, in rare situations the lesion can not be completely removed by ESD and patient require surgery or other interventions like chemotherapy or radiation.
Patients should discuss these risks with their healthcare provider to make an informed decision about their treatment options.
After Endoscopic Submucosal Dissection (ESD), patients will follow specific care instructions to promote healing and monitor for complications.
Post-Procedure Care
- Dietary Restrictions: Patients may need to follow a soft diet for a few days to allow the digestive tract to heal.
- Endoscopic surveillance: After successful removal of tumors by ESD patients require follow-up endoscopy to assess healing and detect any cancer recurrence early.
Monitoring for Complications
Patients should be aware of potential complications, such as bleeding or infection. Contacting the healthcare provider promptly if symptoms arise is essential.
Success Rates and Long-Term Outcomes
ESD has high success rates for removing tumors while preserving healthy tissue. Many patients experience positive long-term outcomes, including reduced recurrence of lesions and improved quality of life.
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Subspecializing in gastrointestinal tract cancers, including the stomach, pancreas, liver, large and small intestine, spleen, anus/rectum, gallbladder and peritoneal cavity.
Call for more information or to schedule an appointment.