Endoscopic Submucosal Dissection: Minimally Invasive GI Care
Endoscopic Submucosal Dissection (ESD) is a cutting-edge, minimally invasive procedure for treating early-stage cancers and precancerous lesions within the digestive tract. Offered at advanced centers like Bumrungrad International Hospital’s Digestive Disease Center, ESD provides a precise, safe alternative to traditional surgery for eligible patients, minimizing risks and accelerating recovery.
What is Endoscopic Submucosal Dissection (ESD)?
Endoscopic Submucosal Dissection (ESD) is a specialized endoscopic procedure that uses a thin, flexible tube equipped with a camera and precise tools to remove lesions from the digestive tract—specifically the esophagus, stomach, colon, and rectum. Unlike traditional surgery, ESD avoids external incisions, accessing the digestive tract through the mouth or rectum. This allows for accurate removal of abnormal tissue with less trauma and shorter recovery times.
How ESD Works: Step-by-Step Process
- Pre-Procedure Preparation: Patients typically undergo the same preparation as for a standard endoscopy. In some cases, additional endoscopy and imaging may be required to determine the lesion's size, location, and type.
- Sedation and Anesthesia: Patients are sedated, and general anesthesia may be administered for optimal comfort and stability.
- Endoscope Insertion: The endoscope is inserted either through the mouth or rectum, reaching the affected area in the digestive tract.
- Lesion Marking and Injection: The doctor uses the endoscope to mark the boundaries of the lesion. A liquid solution is injected beneath it to elevate and separate it from the deeper tissue layers, providing clear visibility and minimizing injury.
- Incision and Dissection: Specialized tools cut around the lesion, allowing its careful removal with precision.
- Extraction and Examination: The lesion is removed in one piece, providing pathologists with an intact sample for detailed evaluation, increasing the chances of complete disease removal and accurate staging.
- Closure (if needed): If required, any small openings in the tissue are closed internally, and the digestive tract is left intact, avoiding the need for larger surgical cuts.
Conditions Treated with ESD
ESD is ideal for patients diagnosed with:
- Early-stage cancers in the esophagus, stomach, colon, or rectum
- Large or flat polyps and precancerous lesions that carry a risk of developing into cancer
- Certain types of subepithelial lesions (growths beneath the surface lining of organs) in the esophagus, stomach, colon, or rectum.
Benefits of Endoscopic Submucosal Dissection
ESD offers distinct advantages over conventional surgery:
- No Surgical Incisions: Since ESD avoids major cuts, it leads to reduced pain and faster healing.
- Complete Lesion Removal: ESD can remove the entire lesion, including the surrounding tissue margin, which provides a more comprehensive pathology evaluation and enhances the curative potential.
- Faster Recovery: With less trauma to the body, most patients experience quicker recovery compared to traditional surgery, allowing a return to daily activities within days.
Risks Associated with ESD
Although ESD is generally safe, it carries some risks:
- Bleeding: Minor bleeding can occur but is usually controlled during the procedure.
- Perforation: There is a rare risk of puncturing the digestive tract wall, which is often manageable during the procedure itself.
- Infection: Though minimal, the chance of infection remains, as with any medical procedure.
Recovery after Endoscopic Submucosal Dissection
Recovery following ESD is typically quick and smooth. Most patients can resume regular activities within a few days, with minimal discomfort. Dietary guidelines might be recommended to support the healing process, and patients usually receive follow-up care to monitor their recovery.
Why Choose ESD Over Surgery?
For eligible patients, ESD provides an attractive alternative to surgery, especially for early-stage cancers or high-risk lesions. Key benefits include:
- Minimized Invasiveness: The absence of incisions means less pain and fewer risks of complications.
- Enhanced Precision: Ideal for early-stage cancers, ESD enables complete removal of lesions, reducing the need for additional treatments.
- Curative Potential: For early-stage cancers and pre-cancerous lesions, ESD can provide a complete cure, eliminating the need for extensive surgical interventions.
Is ESD Right for You?
Endoscopic Submucosal Dissection (ESD) may be suitable if you have an early-stage or high-risk lesion within the digestive tract. Consultation with a specialist is essential to determine eligibility for ESD and develop a tailored treatment plan.
For patients seeking effective, minimally invasive treatment options, ESD offers a promising path forward in digestive health.
The Bumrungrad Advantage in ESD
Bumrungrad International Hospital’s Digestive Disease Center offers the latest in ESD technology, combined with skilled specialists, to ensure the best outcomes for patients with early gastrointestinal cancers or complex lesions. The hospital’s commitment to patient-centered care and advanced procedures makes ESD a preferred option for those seeking minimally invasive solutions with maximal precision.
By Asst. Prof.
Dr. Veeravich Jaruvongvanich, Gastroenterology and Hepatology
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