What is endoscopic submucosal dissection (ESD)?
Endoscopic submucosal dissection (ESD) is an advanced minimally invasive technique used to remove certain gastrointestinal (GI) tumours and precancerous lesions. Developed to treat early-stage cancers in the oesophagus, stomach, and colon, ESD allows complete removal of abnormal tissue in one piece, offering a potential cure while avoiding major surgery.
What is endoscopic submucosal dissection (ESD)?
ESD is a procedure performed during an endoscopy. It involves lifting and carefully cutting out a lesion from the lining of the digestive tract using specialised instruments. The technique allows for en-bloc resection, meaning the entire tumour is removed in one piece, which is essential for accurate diagnosis and reducing the risk of recurrence.
The procedure is typically carried out under sedation or general anaesthesia and may take longer than standard endoscopy due to its technical complexity.
Which conditions can ESD treat?
ESD is primarily used to remove early-stage cancers or large precancerous growths that are limited to the superficial layers of the GI tract. It is most commonly used in:
- Early gastric cancer
- Early oesophageal cancer, especially squamous cell carcinoma
- Colorectal lesions, such as large adenomas or early cancers
- Duodenal lesions, although this is more complex and less commonly performed
Patients are selected carefully based on the depth and spread of the lesion, which is assessed using imaging techniques and biopsy.
How is ESD different from standard polypectomy or EMR?
Standard endoscopic mucosal resection (EMR) is often used for smaller polyps or lesions. However, EMR may involve removing tissue in pieces (piecemeal), which can make it harder to assess margins and may increase the risk of recurrence.
ESD offers several advantages over EMR for suitable cases:
- Complete removal in one piece (en bloc)
- More accurate pathology assessment
- Lower recurrence rates
- Potentially curative without surgery
What are the benefits and risks of ESD?
Benefits include:
- Minimally invasive
- Preservation of organ function, avoiding major resections
- Shorter recovery time and hospital stay
- High cure rates for selected early cancers
Risks may include:
- Bleeding, during or after the procedure
- Perforation of the GI wall, though this is rare and often treatable endoscopically
- Stricture formation, particularly in the oesophagus
Patients are monitored closely during and after the procedure, and most are able to return home within a day or two.
Who is a candidate for ESD?
Not all GI tumours are suitable for ESD. The procedure is most effective when:
- The tumour is confined to the inner layers of the GI tract
- There is no evidence of lymph node or distant spread
- The lesion is flat or slightly raised, not deeply invasive
- The patient is fit to undergo endoscopy under sedation or anaesthesia
