Endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) is a minimally invasive surgical procedure primarily used for the treatment of early-stage gastrointestinal cancers. It allows for the en bloc resection of large lesions and tumors from the gastric tract using an endoscope<ref>Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer. 2007;10(1):1-11.</ref>.

Indications

The procedure is often recommended for patients with:

• Early-stage gastrointestinal cancers
• Large dysplastic lesions
• Tumors that have not invaded deeper layers and do not carry a risk of lymph node metastasis

Procedure

The ESD procedure consists of several main steps:

1. Marking the area around the lesion with an electrocautery knife.
2. Injecting a solution into the submucosal layer to elevate the lesion.
3. Making an incision around the lesion using an electrocautery device.
4. Dissecting the submucosal layer beneath the lesion.
5. Completely removing the lesion.

Following the procedure, the extracted specimen is evaluated histologically to ensure complete tumor removal and to ascertain the depth of tumor invasion<ref>Oyama T, Tomori A, Hotta K, et al. Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol. 2005;3(7 Suppl 1):S67-70.</ref>.

Benefits

• Minimally invasive technique.
• Lower risk of post-operative complications compared to open surgery.
• Allows for larger and deeper tumors to be removed as a single piece (en bloc resection), which is beneficial for histological assessment<ref>Yahagi N, Fujishiro M, Kakushima N, et al. Endoscopic submucosal dissection for early gastric cancer using the tip of an electrosurgical snare (thin type). Dig Endosc. 2004;16(1):34-38.</ref>.

Risks

• Bleeding
• Perforation of the gastrointestinal wall
• Post-operative pain or discomfort
• Infections

Post-Operative Care

Patients may need to remain hospitalized for a short period after the ESD procedure for monitoring. Dietary restrictions may be imposed for several days. Patients are also educated on signs of complications such as severe pain, bleeding, or fever<ref>Fujishiro M. Perspective on the practical indications of endoscopic submucosal dissection of gastrointestinal neoplasms. World J Gastroenterol. 2008;14(27):4289-4295.</ref>.

See Also

• Endoscopy
• Gastrointestinal cancer
• Electrocautery

References

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