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Beverly Hills · 435 N. Bedford Dr., Suite 308Mon–Fri 9:00 am – 5:00 pmMost PPO insurance accepted
Allen KamravaMD · MBA · FACS · FASCRS

Procedure

Endoscopic Submucosal Dissection (ESD)

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Back to work
1-2 weeks
Success rate
85-95%
Recurrence
1-5%

What it is

What is Endoscopic Submucosal Dissection?

Endoscopic Submucosal Dissection (ESD) is an advanced endoscopic technique for the en bloc (one-piece) removal of large, flat, or sessile polyps from the lining of the gastrointestinal tract, particularly the colon and rectum. The procedure involves injecting a solution to lift the lesion, making a circumferential mucosal incision around it, and then meticulously dissecting the lesion off the underlying muscular wall using specialized endoscopic knives. This technique allows for a complete pathologic specimen to be retrieved, which is crucial for accurate staging of early cancers.

Am I a candidate?

Who is a Good Candidate for ESD?

ESD is the ideal treatment for patients with large (typically >2 cm) benign polyps that are not amenable to standard polypectomy or EMR. It is also a primary treatment for select, early-stage (T1) colorectal cancers that are confined to the superficial layers and have a low risk of lymph node metastasis. Ideal candidates are those in whom an en bloc resection is necessary for accurate diagnosis and potential cure, thereby avoiding a more invasive surgical colectomy.

Recovery

What is the Recovery Like?

Recovery after ESD is generally quick, but often involves an overnight hospital stay for observation. Patients may experience some abdominal cramping, bloating, or discomfort for a few days. A clear liquid diet is typically recommended for the first 24 hours, followed by a gradual return to a normal diet. Strenuous activity and heavy lifting are usually restricted for one to two weeks to minimize the risk of complications like delayed bleeding or perforation. Follow-up surveillance colonoscopy is crucial to monitor for any recurrence.

Risks & considerations

What are the Risks?

ESD is a technically demanding procedure with a higher risk profile than EMR. The main risks include:

  • Perforation: Creating a hole in the colon wall is the most significant risk, occurring in 5-10% of cases, and may require surgical repair.
  • Bleeding: Bleeding can occur during or after the procedure (delayed bleeding) and may require endoscopic intervention, blood transfusion, or, rarely, surgery.
  • Post-Polypectomy Syndrome: A transmural burn to the colon wall can cause localized inflammation, pain, and fever, usually managed conservatively without surgery.
  • Incomplete Resection: If the lesion is not completely removed, there is a risk of recurrence, which may require repeat endoscopic resection or surgery.

Sources

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