Endoscopic Submucosal Dissection

Endoscopic submucosal dissection (ESD) is a minimally invasive procedure used to remove tumors in the colon, esophagus, or stomach.

What is ESD?

Endoscopic submucosal dissection (ESD) is an advanced endoscopy procedure that removes abnormal growths, such as lesions and tumors, in the esophagus, stomach, or colon that affect the mucosa, the innermost surface of the gastrointestinal tract. The physician performing the procedure cuts around the lesion and into the layer underneath the mucosa, known as the submucosa, to ensure all unhealthy tissue is removed.

Why is ESD performed?

ESD is performed to remove lesions and tumors in the esophagus, stomach, or colon before they become cancerous. The ESD procedure can also address some early-stage gastrointestinal cancers before they metastasize (spread throughout the body). In some instances, ESD is used to treat precancerous dysplasia or early cancers caused by Barrett’s esophagus, a complication of long-term gastroesophageal reflux disease (GERD) in which repeated exposure to stomach acid leads to abnormalities in the tissue lining the esophagus.

How do I know if I am a candidate for ESD?

To determine whether ESD is the best course of treatment, your physician will evaluate the size, spread, and other characteristics of the abnormal growth using an endoscope, a thin, flexible tube with a camera attached that is inserted into the gastrointestinal tract via the mouth or anus.

You may be a candidate for ESD if one of the following applies to you:

• You have been diagnosed with Barrett’s esophagus which has progressed to a precancerous stage (dysplasia) or to early esophageal cancer
• You have been diagnosed with early colorectal, esophageal, or gastric cancer
• Your physician has identified a precancerous tumor on the inner surface of your colon, esophagus, or stomach

What can I expect during ESD?

Your care team will provide you with detailed information about what to expect before, during, and after the ESD procedure.

Preparing for ESD

The location of your lesion will determine your specific preparation regimen. If the growth is in the colon, you will be asked to prepare your bowels like you would before any colonoscopy, which includes consuming low fiber foods in the days before the procedure and a clear liquid diet the day before your treatment. For all ESD procedures, you will be asked to refrain from eating or drinking beginning at midnight before the procedure. You may also need to stop taking certain medications before your treatment.

To ensure you are not conscious during the procedure, you will be administered general anesthesia before undergoing ESD.

The ESD Procedure

Your doctor will use an endoscope with a small knife attached to perform the ESD procedure.

Once the endoscope is in place, the ESD procedure consists of three main steps:

1. Fluid is injected into the submucosa around the growth, so it can be more readily isolated.
2. The mucosa near the growth is dissected.
3. The submucosal tissue underneath the tissue is cut away.

What can I expect after undergoing ESD?

After the affected tissue is removed from your body, it will be examined by a pathologist to learn more about your condition.

While some patients return home the day of their ESD procedure, others may be asked to stay overnight at the hospital. After your procedure, you will be instructed not to eat or drink anything for the rest of the day and to begin a clear liquid diet the following day. Soft foods can be introduced on subsequent days as you work your way up to returning to your regular diet. You may be prescribed a course of antibiotics in the days immediately following your procedure.

As ESD is a minimally invasive procedure, recovery times after the procedure are relatively short. A follow-up endoscopy will be scheduled 1-2 months after your procedure to assess your recovery. Additional checkups will allow your team to monitor whether your condition returns. Your doctor may recommend additional visits based on the specifics of your condition. While adverse events are uncommon, your doctor will work with you to manage any complications associated with your procedure.

Your experience after ESD may vary based on the type of growth present and the area where the growth was removed. However, most lesions removed from the esophagus, stomach, and colon through ESD are highly unlikely to return in the years after treatment.

Care Team Approach

Digestive Health, a clinical partnership between Ascension Seton and UT Health Austin, takes a multidisciplinary approach to your care. This means you will benefit from the expertise of multiple specialists across a variety of disciplines. Your care team will include gastroenterologists, surgical and non-surgical heartburn and esophageal disorders specialists, physician assistants, nurses, advanced practice providers, dietitians, social workers, and more, providing unparalleled care for patients every step of the way.

We collaborate with our colleagues at the Dell Medical School and The University of Texas at Austin to utilize the latest research, diagnostic, and treatment techniques, allowing us to identify new therapies to improve treatment outcomes. We are committed to communicating and coordinating your care with your other healthcare providers to ensure that we are providing you with comprehensive, whole-person care.

Learn More About Your Care Team