Endoscopic Submucosal Dissection (ESD)

Tumors and polyps in the digestive tract can be detected at very early stages using high resolution endoscopes at an early stage. Polyps and tumors detected at an early stage can now be removed by endospic methods without the need for surgery.

What is ESD?

Endoscopic Submucosal Dissection method (ESD) is a method used for the non-surgical removal of early stage cancers and polyps in the digestive system.

In which diseases is it applied?

Digestive system cancers are among the most common cancer types in Turkey and in the world. It is especially seen in the esophagus, stomach and intestines. It is possible to treat digestive system cancers in early stages with advanced endoscopic methods. The ESD method can be used safely in lesions that occur in the esophagus, stomach, small intestine and large intestine, which are called early stage, that is, it is thought not to pass a certain stage. Cancerous or precancerous lesions in the early period can be removed with this procedure.

What are the Advantages of ESD?

Unlike any surgery, in this procedure, which is performed without creating an incision in the body, patients are usually discharged from the hospital within 1-2 days. Thanks to the high success rate and low complication rate of the ESD method, it has now been widely used in our country as well as all over the world for the removal of polyps and tumors in the early stages. It is especially preferred in elderly individuals, those with heart, kidney disease or different systemic diseases, as it is performed by endoscopy and does not require surgery.

Again, with these methods, early stage superficial colon-stomach-esophagus cancers that have not penetrated deep can also be treated. Thus, treatment can be possible without undergoing a surgical operation. Technological preliminary examinations are used to measure the depth of early-stage superficial cancers. With special endoscopes capable of optical staining, special staining (chromoendoscopy), magnified endoscopes with magnifying properties and examination methods using endoscopic ultrasound, the depth of the tumoral structure can be directly measured by examining the colon walls as well as the inner surface of the colon.

How is ESD applied?

The ESD process is performed with devices called endoscopes equipped with high-definition video cameras and other devices. If the procedure is to be performed in the large intestine area, the patient should have cleaned the intestines with various drugs as recommended by the doctor, as in the preparation for colonoscopy. If the application will be made in the stomach, small intestine or esophagus region, at least 8 hours of fasting is sufficient. It is applied under anesthesia in the ESD endoscopy unit. The endoscope, called a thin tube with a high-resolution camera at the end, is entered into the relevant area. The lesion is removed as a complete piece with special endoscopic cutters and special blood-stopping devices passed through the channel of the endoscope.

What are the advantages for the patient?

ESD is a non-surgical procedure used in the treatment of early-stage digestive system cancers. It is applied endoscopically. No incision is made on the body.

Patients start walking a few hours after the procedure and feel better as if the procedure had not happened.
Cancer patients do not need chemotherapy after this procedure. However, when the lesion is removed, if it is revealed that it extends to the very deep muscle tissue, a new evaluation is made together with the surgery and oncology specialists.
Accurate staging can be done in ESD as the lesion is excised by scraping. If the cancer is in the early stages, it is a curative procedure. Even if it is not at an early stage, it is helpful in determining the stage of the disease and the treatment path to be followed.

Curiosities About ESD

How long does the process take?

Depending on the location, size and endoscopic appearance of the polyp, lesion, and early stage tumor, it may last from half an hour to several hours.

Is hospitalization required?

In order to follow the general condition of the patient after ESD, he should stay in the hospital for 1 night.
What should be considered in the post-procedure diet?
It is recommended that patients be fed with liquid and soft foods first. Instead of oily and spicy foods, more liquid soft meals such as yogurt, soup, pudding, compote, vegetable dishes should be consumed.

Should polyps be removed?

A polyp is an abnormal growth of tissue. When it grows in the digestive system, certain types of it cause digestive system cancers. In the stomach, this process takes place a little faster. An average period of 5-6 years can be observed in the large intestine from polyp to tumor stage. However, polyps must be removed as they can pose a risk.

What are the risk factors for polyp formation?

Familial factors are very effective in polyp formation. People with a history of polyps in their 1st or 2nd degree relatives should be careful in this regard. Polyp development, such as smoking and alcohol use, obesity, fast food consumption, excessive consumption of fatty carbohydrate foods, and wrong eating habits can cause polyp formation.are risk factors.

How to protect from polyps in the large intestine?

Colon cancers may not cause any symptoms. It can progress until it becomes a dispersed form in the liver without giving any symptoms. For this reason, it is recommended to enter screening programs after the age of 45, even if there are no complaints. Fecal occult blood test, fecal immunochemical test called fit is important in terms of indicating whether there are polyps in the intestine. However, the most sensitive method is endoscopic examinations.

Can it be understood that there is a polyp in the large intestine?

Bleeding in the large intestine, changes in bowel habits, constipation or diarrhea can be seen. There may be thinning of the stool. There may be complaints such as abdominal pain, sometimes swelling in the abdomen, gas. These tables should also be considered for those under the age of 45.

Does stomach cancer and lesions give symptoms?

Nausea and vomiting may occur in gastric cancers or early-stage lesions. If the tumor is located in the upper part of the stomach, difficulties in swallowing, blood coming from the mouth, blood in the stool or black stool are among the symptoms. Abdominal pain that does not respond to drug therapy should also be considered.

Can ESD be applied in stomach cancer and polyps?

Early detection of tumors is the first condition for the application of ESD in the digestive system. The ESD method is also used in gastric cancers detected at an early stage.