Endoscopic Submucosal Dissection (Esd)

What Is Endoscopic Submucosal Dissection (ESD)? Non-Surgical Tumor Treatment

Cancers of the digestive system, seen in the esophagus, stomach, or intestines, are fairly common types of cancer. In the treatment of digestive system cancers, endoscopic methods have increasingly come to the forefront in recent years. Endoscopic Submucosal Dissection, or ESD, is especially defined as a non-surgical tumor treatment for digestive system cancers.

At Daviva Health Group, the ESD method, which helps prevent organ loss even in extensive lesions, is safely performed by our expert academic teams.

In our article, you can find answers to questions such as whether ESD completely removes the cancer and whether ESD or open surgery is safer.

What Is ESD?

It is an advanced endoscopic technique used to remove early-stage digestive system cancers and high-grade risky lesions in one piece. Unlike Endoscopic Mucosal Resection (EMR), ESD allows complete removal of larger, deeper, or more complex lesions, especially in the stomach, esophagus, colon, and rectum.

How Is ESD Treatment Performed?

• ESD is usually performed under general anesthesia. Therefore, fasting and not drinking are required before the procedure.
• If ESD treatment will be performed in the lower digestive system, that is, in the intestines or rectum, it may be necessary to empty the bowels with an enema before the procedure.
• After anesthesia, the endoscope is inserted through the mouth or anus depending on the area where the procedure will be performed.
• The endoscopy device is advanced to the area where the procedure will be performed. During this time, the endoscope images are followed on a screen to avoid damaging surrounding tissues.
• The borders of the tumor or suspicious lesion are marked with a special tool passed through the endoscope.
• A special fluid is injected under the tumor to separate it from the healthy muscle tissue. This step is a precaution taken to prevent damage to healthy tissues during tumor removal.
• Using an electrosurgical knife that delivers high-frequency electrical current, the tumor tissue is cut away from the area where it is located. The tumor is completely removed and extracted with a small forceps.
• A small device, clip, or stitch may be used to stop bleeding.

What Are the Advantages of ESD?

Endoscopic Submucosal Dissection (ESD), which allows large and complex tumors to be removed in one piece without surgery, offers significant advantages in the treatment of early-stage digestive system cancers.

The advantages of ESD can be listed as follows.

• It allows large lesions to be removed in one piece. This is very important for an accurate diagnosis and complete treatment.
• Being performed endoscopically minimizes possible risks.
• It does not compromise the integrity of the organ where the procedure is performed, such as the stomach or esophagus. It allows only the tumors to be removed while preserving organ integrity.
• Since even large tumors are completely removed with the ESD procedure, the risk of cancer recurrence is lower than with other procedures.
• Complete removal of the tumor allows pathology results to be assessed more precisely.
• Because it is an endoscopic procedure, there is no scar or surgical mark on the skin.
• Recovery and return to social life happen much faster.
• Infection and pain are easier to control compared with surgical procedures.
• It is a safe alternative for elderly patients or those with additional illnesses who cannot undergo surgery.

Who Can ESD Be Performed On?

ESD is performed especially to remove some tumors that do not have clear borders or that are too large to be removed in one piece by other methods.

• In general, ESD can be performed in the following situations.
• Early-stage esophageal cancers
• Early-stage stomach cancers limited to the mucosal layer
• Early stages of colon and rectal cancer
• Polyps with a risk of becoming cancerous
• Some benign polyps that cannot be treated during colonoscopy
• It is a safe option for elderly patients and those with additional illnesses who are not suitable for open surgery.

ESD or Open Surgery? Which Method Should Be Used?

In the treatment of digestive system cancers, there are situations in which ESD and open surgery each have their own advantages. Which method will be used in treatment varies according to the person and the stage of the cancer.

• For early-stage digestive system cancers and precancerous lesions, Endoscopic Submucosal Dissection (ESD), provided the patient is an appropriate candidate, is generally considered a safer and less invasive method than open surgery.
• ESD has advantages over open surgery, including faster recovery, less pain, and fewer serious complications.
• After ESD treatment, patients usually recover much faster. Hospital stays are short. After open surgery, a longer hospital stay is needed to manage pain and monitor issues such as infection.
• However, open surgery remains a safer option for advanced-stage or deeply seated tumors. This is because it allows the removal of lymph nodes, which ESD cannot do.

Frequently Asked Questions About ESD

What should nutrition be like after ESD?

After Endoscopic Submucosal Dissection (ESD), nutrition is one of the most important issues. It is important to follow dietary rules so as not to irritate the area where the procedure was performed and to minimize the risk of bleeding. A temporary ulcer may form after ESD. In order for this ulcer to heal properly, the dietary rules set by the doctor should not be neglected.

• On the day of the ESD procedure, a liquid diet such as broth or apple juice is usually recommended.
• For the first 1-2 days after the procedure, easy-to-digest soft foods such as yogurt, scrambled eggs, and soup should be consumed.
• From the 3rd day onward, you can gradually switch to soft foods such as mashed potatoes, vegetable purée, soft fruits, and well-cooked pasta.
• During this process, meat and dry foods should be avoided.
• Instead of very hot or very cold foods, lukewarm or cool foods should be consumed.
• Especially for the first 2 weeks after ESD, nuts, raw vegetables, crackers, spicy foods, and fatty foods should be avoided.
• Smoking must definitely not be done during this period.

What Is the Difference Between ESD and EMR?

Endoscopic Submucosal Dissection (ESD) and Endoscopic Mucosal Resection (EMR) are similar procedures. However, there are differences between ESD and EMR.

The differences between ESD and EMR can be listed as follows

• In the EMR procedure, a special loop is used to identify and remove lesions. In the ESD procedure, special knives are used to cut beneath the lesion.
• EMR is generally used for small lesions. ESD, on the other hand, is used more often for larger lesions and those suspected of being cancerous.
• The recurrence rate is lower with ESD. However, the risk of perforation is higher with ESD. The risk of perforation is lower with EMR.
• Because deeper tissues are also removed in the ESD procedure, the procedure takes longer than EMR.

Does the ESD procedure completely remove the cancer?

Endoscopic Submucosal Dissection (ESD) is a highly effective treatment method for early-stage digestive system cancers. However, it does not absolutely guarantee complete elimination of cancer in every case. In very early-stage cancers, the healing rates are very high. The success of ESD also depends on the cancer being superficial and not having spread to the lymph nodes.

How long does the ESD procedure take?

The duration of ESD treatment varies depending on the size, location, and complexity of the lesion. The ESD procedure is usually completed within 1-3 hours.

How long should I stay in the hospital after ESD?

Recovery after ESD is much faster compared with open surgery. Still, patients are kept under observation in the hospital for 1-2 days after the procedure.

Is pain felt during the ESD procedure?

The ESD procedure is mostly performed under general anesthesia. Therefore, the patient does not feel anything during ESD treatment. After the procedure, pain and bloating may occur. However, these complaints are symptoms that can be controlled with simple medications.

Is there a risk of the tumor recurring after the ESD procedure?

One of the biggest advantages of the ESD procedure is that the tumor can be removed in one piece. If the tumor can be removed in one piece, the risk of recurrence after ESD is very low. However, recurrence is still seen in some cases.