Endoscopic Submucosal Dissection (ESD)

Overview What to Expect Our Expertise & Doctors FAQ

What is an endoscopic submucosal dissection (ESD)?

Endoscopic submucosal dissection (ESD) is a type of therapeutic endoscopy used to remove large polyps or early cancers in the colon or anus without the need for surgery.

This is an advanced procedure that uses an endoscope to accurately remove growths without removing the organ involved.

An endoscope is a thin and flexible tube that is equipped with a camera and tools.

Why do you need an ESD?

An ESD is used for the complete removal of growths that occur in the gastrointestinal tract.

This includes the oesophagus (the 'food tube'), stomach, small bowel and colon.

It is used for:

Certain patients with Barrett's oesophagus
Early-stage cancerous tumours or colon polyps
Staging of cancer (determining the cancer level) to develop treatment plans
Tumours of the oesophagus, stomach or colon that have not yet entered the deeper layer of the GI wall, with minimal or no risk of cancer spreading

What are the risks and complications of ESD?

The risk of complications depends on your general health and the type of procedure performed.

ESD, if performed successfully, allows the patient to avoid the need for surgery. However, some possible complications of the procedure include:

Bleeding
Narrowing of the stomach and oesophagus
Perforation of the tract

How do you prepare for an ESD?

Before the operation, your doctor will review your medical history. You may also undergo some scans and tests.

Once your procedure is scheduled, your doctor will advise you on how to prepare.

In general, you need to fast for 6 – 8 hours before the procedure.

Note: If you are taking any medication or herbal supplements, you should inform your doctor. You may need to adjust or stop taking some medication before the procedure (e.g. aspirin, blood thinners).

What can you expect in an ESD?

Endoscopic submucosal dissection is performed under monitored sedation or general anaesthesia.

Depending on the extent of surgery, the procedure may be done as an outpatient procedure, or you may be warded for a few days to monitor your recovery.

During the procedure

Illustration of the steps in an endoscopic submucosal dissection (ESD).

During endoscopic submucosal dissection:

An endoscope will be inserted either through the mouth or anus.
It is guided to the area where the tumour is located.
A solution is injected submucosally (beneath the mucous membrane) to raise the area affected by the tumour. This helps to separate the growth from surrounding tissues and minimise damage.
A special knife is used to resect (cut away) the tumour.
The growth is removed and sent for testing.

Frequently asked questions

A: Both gastric and oesophageal ESD uses the ESD technique to remove growths.

Gastric ESD removes growths in the stomach, while oesophageal ESD removes growths in the oesophagus (food pipe).

A: Endoscopic mucosal resection (EMR) is used to remove early-stage cancers and pre-cancers.

The technique uses a tool to 'pinch' the tissues that need to be removed while an electrosurgical current cuts it away. It is best used for areas about 15 to 20mm in size. Larger growths have to be removed piece by piece.

Typically, it is deployed for growths that have not yet entered the deeper layer of the gastrointestinal wall, with minimal or no risk of cancer spreading.

ESD is used to remove growths in a single piece. A solution is injected beneath the mucous membrane to separate the growth from surrounding tissues. A special knife is used to remove the growth as a whole piece.

It is usually used for growths that are more aggressive, or have a risk of recurrence.

A: Resection is a surgical term that refers to the removal of a diseased or damaged part of an organ or bodily structure.

Dissection refers to cutting apart tissue or removing a complete organ or piece of tissue for diagnosis or study.

Why choose Mount Elizabeth Hospitals?

With a track record of over 40 years, the gastroenterology teams at Mount Elizabeth Hospitals are known in Singapore and the region for delivering quality health care.

Our specialists have years of experience in gastroenterological procedures, including advanced procedures such as endoscopic submucosal dissection.