Endoscopic Submucosal Dissection (ESD)

Endoscopic submucosal dissection is a minimally invasive outpatient procedure that may be performed to remove a precancerous lesion or early-stage gastrointestinal (GI) tumor from the lining of the digestive tract. ESD is a technically challenging procedure that requires advanced endoscopic skills as well as a thorough understanding of the anatomy and pathology of the GI tract. For these reasons, it is best performed by a physician who has specialized knowledge and skills, such as an experienced gastroenterologist.

What does endoscopic submucosal dissection involve?

When performing an ESD procedure, a physician will insert a flexible, tube-like tool with a powerful light source and tiny camera attached to the end (endoscope) into the mouth or anus, depending on the location of the targeted lesion. After carefully guiding the endoscope into the digestive tract, the physician will use the camera to capture detailed images of the GI wall, which will be displayed on a nearby monitor in real time. Guided by the images, the physician will use an electrosurgical knife with a high-frequency electrical current to separate the lesion from the surrounding tissue and remove it in one piece. This approach can help prevent the spread of a cancerous tumor.

Compared to traditional endoscopic procedures, ESD allows for more precise and complete removal of submucosal lesions located near muscle tissue, which can be challenging to remove. It may also be a good option for removing a lesion that does not have clearly defined borders.

What conditions can be treated with endoscopic submucosal dissection?

ESD may be considered for treating:

• Barrett’s esophagus (a precancerous condition of the esophagus)
• Benign colon polyps
• Cancerous tumors in the esophagus, stomach or colon that have not invaded the deep layers of the GI wall

ESD can also help a physician stage a gastrointestinal tumor by evaluating its extent and spread. This information can then be used to plan further treatment if necessary.

What happens after an endoscopic submucosal dissection?

Immediately after an ESD procedure, the patient will be monitored in a recovery room while the sedative wears off. The removed tissue will be sent to a laboratory, where a pathologist will examine it under a microscope for evidence of cancer.

During recovery, some patients experience temporary discomfort, such as:

• Sore throat, if the endoscope was passed through the mouth
• Upset stomach or vomiting, if the stomach or intestine was treated
• Abdominal cramping, bloating and gas, if the physician inflated the abdomen with air for increased space and visualization during the procedure

Benefit from world-class care at Moffitt Cancer Center

Endoscopic submucosal dissection is a complex procedure that requires highly refined expertise, and Moffitt is one of only a few high-volume cancer centers in the United States that offer it. Nationally recognized for our groundbreaking research, Moffitt also has a robust clinical trials program that provides our patients with unique opportunities to be among the first to benefit from promising new treatment options.

If you would like to learn more about ESD, you can request an appointment with a specialist in Moffitt’s renowned Gastrointestinal Oncology Program by calling 1-888-663-3488  or submitting a new patient registration form online. We do not require referrals.