Endoscopic Submucosal Dissection (ESD)

What is endoscopic submucosal dissection?

ESD is a type of treatment for cancer in the stomach or esophagus. The procedure is done to remove a tumor that has grown into the second layer of the wall of the stomach or esophagus. This layer is called the submucosa. For some people, ESD may be an option instead of surgery to remove the stomach or part of the esophagus.

During the procedure, a flexible tube with a camera and light (endoscope) is gently put down the throat. It is guided into the esophagus and stomach. The tumor is cut out with small tools and removed. In some cases, it may also be done to remove pre-cancer tissue in the esophagus. This is known as Barrett’s esophagus.

Why might I need an ESD?

Stomach and esophageal cancer are often treated with surgery. The goal is to take out the tumor and an edge (margin) of healthy tissue around it. Different kinds of surgery can be done. The type you have depends on the type of cancer, where it is, how much it has spread, and other factors.

Endoscopic submucosal dissection (ESD) might be an option for you if:

• The tumor is small

• Your surgeon thinks all of the cancer can be safely removed

• The cancer has not spread to lymph nodes or other parts of your body

• You are healthy enough for this surgery

• The surgeon is well trained in ESD

What are the risks of an ESD?

All surgeries have some risks. The risks of this surgery include:

• Excess bleeding

• Infection

• Hole (perforation) in the esophagus or stomach

• Narrowing (stricture) in the esophagus

• Blood clots

• Damage to nearby organs or tissue

• Tumor is not fully removed

Your risks depend on your overall health, the type of surgery you need, and other factors. Talk with your healthcare provider about which risks apply most to you.

How do I get ready for an ESD?

Talk with your healthcare provider about how to prepare for your surgery. Tell them about all the medicines you take. This includes over-the-counter medicines, vitamins, and other supplements. You may need to stop taking some medicines before the procedure, such as blood thinners and aspirin. If you smoke, you may need to stop before your surgery. Smoking can delay healing. Talk with your healthcare provider if you need help to stop smoking.

You may need some tests before the procedure, such as:

• Blood tests, to check your overall health

• ECG, to check the health of your heart

Tell your healthcare provider if you:

• Have had any recent changes in your health, such as an infection or fever

• Are sensitive or allergic to any medicines, latex, tape, and anesthetic agents (local and general)

• Have a history of bleeding disorders

• Are taking any blood-thinning (anticoagulant) medicines, aspirin, ibuprofen, or other medicines that affect blood clotting

• Are pregnant or think you may be pregnant

Also make sure to:

• Ask a family member or friend to take you home from the hospital.

• Follow all directions you are given for not eating or drinking before surgery.

• Follow all other instructions from your healthcare provider.

You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully. Ask questions if something is not clear.

You’ll also talk with an anesthesiologist. This healthcare provider will give you the general anesthesia. This medicine makes you sleep during surgery and keeps you from feeling pain. They also monitor you closely during surgery to keep you safe. You will be asked about your health history and the medicines you take. You will also be asked to sign a consent form for the anesthesia to be given.

What happens during an ESD?

On the day of surgery, you’ll be taken into the operating room. Your healthcare team will include your anesthesiologist, surgeon, and nurses.

During the surgery:

• You’ll be moved onto the operating table.

• You'll be attached to equipment that monitors your vital signs. This includes your heart rate, blood pressure, and breathing.

• You may be given medicine to help you sleep and to prevent pain. This is given through an IV (intravenous) line placed in a vein in your arm or hand. Your throat may be numbed with a spray or liquid.

• A small plastic guard will be used to protect your teeth. You will be given extra oxygen to breathe. This is done through small prongs that fit just inside your nose.

• The surgeon will place the flexible tube with a camera and light (endoscope) in your mouth. They gently move the endoscope down your throat into your esophagus and stomach.

• Air is used to expand your GI tract so the lining can be seen more clearly.

• The scope sends pictures of your GI tract to a computer screen. The healthcare team can see your esophagus and stomach.

• Small tools are passed through the endoscope. The surgeon marks the edges of the tumor. They use a needle to inject fluid under the area where the tumor is growing. Healthy tissue under the tumor is cut with a very thin, sharp tool. The tumor is lifted out fully and removed with a small clamp.

• The surgeon may use a small tool, clips, or stitches to stop bleeding in the area or fix a hole.

• The endoscope is then removed.

What happens after an ESD?

After the procedure, you will spend some time in a recovery room. Your healthcare team will watch your vital signs, such as your heart rate and breathing. You may need to stay at the hospital for a day or more. Your healthcare team will tell you the results of your surgery and if you need other treatment.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure