Do you need a large incision to remove tumors inside the stomach? Let's talk about Endoscopic Submucosal Dissection

Has your doctor told you that you have a small abnormal tissue, tumor, or polyp in your digestive system, that is, in your stomach or esophagus? When we hear that, the fear that comes to our mind is, "Oh, will I have to do a major operation now?" But with today's advanced medical science, there is no need to do surgeries that cause large incisions for everything. That's why we are going to talk about a wonderful treatment method that can cause minimal damage to the body and heal quickly.

Simply put, what is Endoscopic Submucosal Dissection?

While the name may sound a bit complicated, the procedure is actually quite simple. Endoscopic Submucosal Dissection , or ESD for short, is a non-invasive procedure that removes abnormal tissue, lumps of cells that could become cancerous, or small tumors from inside your gastrointestinal tract.

Imagine this is done by a gastroenterologist. He uses a long, flexible tube with a camera on the end. We call this an endoscope.

• If the problem is in your upper digestive system (for example, esophagus, stomach), this endoscope is inserted through your mouth.
• If the problem is in your lower intestinal tract (large intestine, rectum), it is inserted through the anus.

This is done using a small surgical instrument that is inserted into the tube and, under the guidance of a camera, is used to carefully cut out and remove the abnormal tissue. The best part is, all of this happens inside the body. Since there are no external incisions, you can recover faster, have less pain, and avoid scarring.

What types of medical conditions is ESD used for?

This ESD treatment is usually used to remove precancerous or early-stage cancers in the digestive system. Let's take a look at what they are.

What is the difference between ESD and EMR?

You may have heard of another similar procedure, called Endoscopic Mucosal Resection (EMR) . While both procedures are less invasive, there is a slight difference.

The wall of our digestive system is made up of several layers. The innermost thin membrane is called the mucosa.

• EMR method: This mainly removes tumors that are only in the innermost layer called the mucosa. This involves injecting a liquid under the tumor, lifting it, and cutting it off with something like a metal loop.
• ESD method: This is a slightly more advanced method than EMR. It can remove tumors that are in the mucosa, as well as tumors that have spread to the layer just below it. The biggest advantage of this is that the abnormal tissue, no matter how large, can be removed in one piece . Then it is easy to send it to the laboratory and accurately confirm whether the cancer has been completely removed.

How should I prepare before this treatment?

Your doctor will give you a clear set of instructions before this treatment. It is very important to follow them exactly.

• If you are having treatment on the upper gastrointestinal tract: (esophagus, stomach) you will need to completely abstain from eating and drinking for several hours before the treatment. This means that your stomach must be empty.
• If you are having treatment for your lower gastrointestinal tract: (large intestine), you will be asked to have a "bowel prep." This involves emptying your large intestine completely by drinking a special liquid ( laxative ). This allows the doctor to see the inside clearly with the endoscope.

What happens during treatment?

You will not feel any discomfort or pain during this treatment. This is because you will be anesthetized. You may be put completely to sleep (General Anesthesia), or you may be given a type of anesthesia that makes you feel drowsy and relaxed (Monitored Anesthesia Care).

During treatment, your doctor will follow these steps:

1. The endoscope is inserted through the mouth or rectum.

2. Using the camera, the endoscope is sent to where the abnormal tissue is located.

3. Using a device passed through the endoscope, a mark is made around the tumor to be removed.

4. Next, a special liquid is injected into the membrane under the tumor. This creates a cushion underneath the tumor, lifting it up from the surrounding healthy tissue. This makes it easier to separate and cut it out.

5. Finally, using a special device such as a high-frequency electrical knife, the tumor is carefully cut along the marked line and removed.

The entire procedure can usually take between one and three hours , depending on the size and location of the tissue being removed.

What happens after treatment?

After treatment is complete, the removed tissue is sent to a laboratory where a pathologist examines it to see if it contains any cancer cells and whether it has been completely removed.

You will be taken to a recovery room for a short time after the treatment. Once the effects of the anesthesia have fully worn off, you may be able to go home the same day, or you may need to stay in the hospital overnight. You should definitely be accompanied home by someone , as it can take up to 24 hours for the effects of the anesthesia to fully wear off.

Are there side effects and risks?

As with any medical treatment, there are minor side effects and very rare risks.

Possible minor side effects

These usually disappear completely within a day or two.

• Filling the stomach
• Stomach ache
• Gas and the pain it causes
• Nausea or vomiting
• Sore throat (if the endoscope was inserted through the mouth)

It may be normal to have a very small amount of blood in your stool, but it should stop within 24 hours.

Rare complications

The likelihood of these occurring is very low, but it's important to be aware of them.

• Bleeding: Bleeding from the site of tissue removal.
• Gastrointestinal perforation: A perforation of the wall of the gastrointestinal tract by an endoscope or instrument.
• Scarring: Especially when treating the esophagus, scarring that occurs during healing can lead to narrowing of the esophagus (esophageal strictures).

What are the advantages of this method?

The ESD method has many advantages compared to open surgery.

• Less pain: There is much less pain because there are no incisions.
• Quick recovery: You can return to normal life and work quickly.
• No scars: No scars appear on the outside of the body.
• Fewer complications: There is a lower risk of complications than open surgery.
• Organ preservation: This method can avoid things like removing part of the stomach or intestine that would otherwise be done during major surgery.

When should you see a doctor immediately?

When you go home after treatment, if you experience any warning symptoms, it is very important to call your doctor or go to the nearest hospital Emergency Department (ETU) without delay .

How long does it take to heal?

Most people can return to work after about five days. However, if you do a very strenuous job, such as lifting heavy objects, your doctor may advise you to rest for a little longer. There may be slight changes in bowel habits for about a week after treatment.

You will usually see your doctor again in about two weeks. At that time, they will explain the results of the lab report to you and decide whether or not further treatment is needed.

ESD is a very successful treatment. Some studies have shown that the risk of a tumor recurring in the same location in people who have undergone this treatment is as low as 1%.

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