What is Endoscopic Submucosal Dissection?
Endoscopic submucosal dissection (ESD) is a minimally invasive procedure for removing gastrointestinal precancerous lesions. EMR is most effective for lesions that are too large to be safely removed in an ambulatory surgery center and require removal in one piece. These lesions are generally not suspected to be malignant based on their endoscopic appearance and/or biopsies, however some very early cancers can be removed with ESD. Biopsies are not always taken as they can make ESD more difficult.
Before the procedure:
You will complete a prep similar to the prep completed for a standard colonoscopy. Your medical history will be reviewed with you by your healthcare team including a nurse, your gastroenterology physician and an anesthesia provider. An IV line will be placed.
During the procedure:
During your procedure, the anesthesia provider will administer medications and monitor your vital signs. Generally, these medications are similar to those that you received during your initial colonoscopy, but that decision is ultimately made by the anesthesiologist in the hospital. Your gastroenterology physician will insert an endoscope into your rectum and locate the lesion that needs to be removed. The physician may inject a solution underneath the lesion to help lift it. The physician will use an electrosurgical knife with a high-frequency electrical current to “cut” the lesion free from the GI wall. The electrical current seals blood vessels to reduce bleeding. The lesion will be retrieved and sent to the lab for testing.
After the procedure:
At the end of the procedure, you will be taken to a recovery area. The physician will talk with you about the initial results of your procedure and will prepare a full report. You may have some cramping or bloating after the procedure which is normal. Any tissue will be sent to the lab for evaluation. Your care team will provide you with instructions on resuming normal activities and your diet following the procedure.
Are there possible complications from ESD?
Although serious complications are rare, any medical procedure has the potential for risks. Risks from ESD include: perforation, or a tear through the lining of the colon, bleeding, reaction to medications, heart and lung problems, and dental or eye injuries. Please keep in mind that bleeding can occur both during the procedure, in which case it is generally manageable, and, in a very small number of people, within two weeks after the procedure. A subset of patients with delayed bleeding may require additional procedures to stop the bleeding, generally in the hospital.
