Endoscopic Submucosal Dissection (ESD)
Endoscopic submucosal dissection (ESD) is an advanced endoscopic technique allows for removal of superficial tumors located throughout the gastrointestinal tract. With this method, superficial tumors located in esophagus, stomach, intestine or colon can be removed in one piece with fast recovery, less pain and short hospitalization when compared to laparoscopic or open surgery.
ESD is still only performed in few centers. This procedure requires high degree of expertise and training. The first and most important step is to identify the superficial lesion correctly throughout the gastrointestinal tract. Lesions invading deeply through the gastrointestinal wall have a risk of lymh node spread precluding endoscopic removal. This identification requires high-tech imaging, analysis of the superficial architecture and in some cases endoscopic ultrasound.
After lesion identification, ESD steps are as follows:
(1) the lesion is marked;
(2) a lifting agent is injected under the lesion to elevate it;
(3) the lesion is cut circumferentially using an electrosurgical knife;
(4) the base of the lesion is dissected (cut) until the lesion has been completely resected;
(5) any intraprocedural bleeding that occurs during cut or submucosal dissection is managed by using hemostatic forceps or clips to guarantee vessel coagulation and hemostasis.
The lifting solution is injected into the submucosal layer (under the lesion), and dissection is performed in this layer. The name ‘endoscopic submucosal dissection’ stems from this consept.
ESD may treat:
- Tumors of the esophagus, stomach, intestine or colon that have not yet entered the deeper layer of the gastrointestinal wall. This kind of superficial tumors have no or negligible risk of cancer spreading.
- Colon polyps that are difficult or not amenable to treat by standard polypectomy or mucosal resection. This type of tumors are generally large and flat type.
