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Endoscopic Submucosal Dissection (ESD)

Endoscopic submucosal dissection (ESD) is an outpatient procedure to remove deep tumors from the gastrointestinal (GI) tract. Gastroenterologists (doctors specially trained to treat the GI tract) use flexible, tube-like imaging tools called endoscopes to perform ESD. Most people go home the same day.

Only a few centers in the United States perform ESD because the procedure requires a high degree of expertise with the procedure. Our gastroenterologists have helped many patients recover faster, often with less pain, than with open or laparoscopic surgical procedures.

Endoscopic Submucosal Dissection: Why It’s Performed

In some cases, ESD is a more effective option than endoscopic mucosal resection for removing growths or tumors. ESD’s outcomes are comparable to those of surgical interventions.

ESD may treat:

  • Barrett’s esophagus
  • Early-stage cancerous tumors or colon polyps
  • Tumors of the esophagus, stomach or colon that have not yet entered the deeper layer of the GI wall, with minimal or no risk of cancer spreading
  • Staging of cancer (determining the cancer level) to develop treatment plans


A Rare, Stomach-Saving Endoscopic Procedure

A lot of people in the U.S. don’t know about endoscopic submucosal dissection. Patients find it on the internet and come to us. Many referring physicians may not even know about this option.

— Saowanee Ngamruengphong, M.D.

Read full article >

human digestive system graphic


Endoscopic Submucosal Dissection: How to Prepare

Before your procedure:

  • For a lower GI tract procedure, follow a liquid diet plus a laxative or enema to cleanse the bowel.
  • For an upper GI tract procedure, do not eat or drink for 12 hours before the procedure to ensure your esophagus is clear of food.
  • Alert your doctor to any allergies you may have.
  • Follow your doctor’s instructions about whether to take your prescription medications.

Endoscopic Submucosal Dissection: What to Expect

On the day of your procedure, plan to arrive at the endoscopy unit three or more hours before the procedure. You will register and provide your medical history, including any medications you have taken. Be sure a driver is available to take you home.

During the procedure, your gastroenterologist will:

  1. Place an IV into your vein to deliver either a sedative to make you drowsy or anesthesia to put you to sleep. The level of sedation depends on the tumor’s location.
  2. Insert a high-definition endoscope through your mouth or your anus, depending on the location of the tumor. Your doctor will observe the images on a screen.
  3. Locate the tumor and mark its border with a special tool passed through the endoscope.
  4. Inject the layer beneath (submucosa) with a solution to lift it away from the muscle wall. This separation aims to minimize damage to surrounding tissue during the procedure.
  5. Use an electrosurgical knife with a high-frequency electrical current to “cut” tumor tissue free from the GI wall, then continue to use the electrosurgical knife to cut away the tumor. The electrical current stops any active bleeding.
  6. Remove the tissue from the body through the endoscope and send it to a laboratory. Examination under a microscope can confirm whether the procedure completely removed the tumor.

After the procedure, we will monitor your recovery while the sedative wears off. This procedure can be done as an outpatient procedure, or it may require an overnight hospital stay. Your doctor will discuss your results with you before you leave.

Common side effects may include:

  • Sore throat
  • Nausea or vomiting
  • Excessive gas, bloating or cramping

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