Endoscopic Submucosal Dissection (ESD)

Endoscopic Submucosal Dissection (ESD) is a minimally invasive, endoscopic technique developed to remove pre-cancerous and early cancerous lesions of the GI tract. ESD uses an endoscope (a long, flexible tube) that is inserted into the mouth or rectum. Through this tube, various devices can be inserted to resect, or remove, these lesions.

The lesions are “lifted” away from the muscle layer of the GI tract using a blue-colored dye, or “lifting agent” that is injected below the lining of the GI tract. This allows us to remove the lesion by cutting through the superficial layer, while protecting and preserving the deeper muscle. This allows us to preserve as much organ as possible when removing these lesions, which previously would require major surgeries with prolonged recovery time.

You should eat nothing by mouth after 10PM the night before your procedure. Clear liquids like water are okay to drink up to 6AM the morning of your procedure.

Risks of ESD include bleeding, infection, side effects of the medications used to put you to sleep, or perforation. Perforation occurs from damage to the muscle of the GI tract. This is very rare but could result in the need for an emergency surgery. For ESD in some locations, a “stricture”, or narrowing, may develop after the procedure. These often require subsequent procedures to stretch the narrowing open.

Will I have to stay in hospital?

You may be kept in hospital for monitoring overnight and will be discharged early the following morning. In some cases, you may be discharged the day of the procedure.

Will I have a scar?

Since ESD is performed through a tube that is inserted into the mouth or rectum, you will not have a scar on your skin.

Your physician will instruct you on which medications to take depending on the location of your ESD (esophagus, stomach, or bowel)

Diet: Esophagus

• Day 1: You will have nothing by mouth the day of your procedure.
• Day 2: You can have liquids and gelatins (eg: Jello, popsicles, or any thin liquid) the day following your procedure.
• Day 3: Advance diet to thick liquids (eg: soups, pudding, smoothies).
• Day 4-7: You can advance your diet to solids, as tolerated.

Diet: Stomach and Colon

• Day 1: You may have ice chips and sips of water but no full meals.
• Day 2: You will begin with liquids and advance to a full diet throughout the day.

If your ESD was in the esophagus, you may have ongoing discomfort with swallowing for upwards of 10 days after the procedure. You should continue to take your proton pump inhibitor (acid lowering medication) and viscous lidocaine for symptomatic relief.

Return to the Emergency Room if you experience any of the following:

• Throwing up or vomiting blood
• Bloody or black, tarry bowel movements
• Severe abdominal pain or chest pain
• Intractable nausea or vomiting
• Fever > 38.5°C

You will have a phone call with your physician 1-4 weeks after the procedure and will discuss when your next endoscopy will be (timing dependent on where your ESD was and what the pathology specimen shows).