Has the doctor told you that you have a small tumor in your colon or esophagus that needs to be removed? When you hear that, many of us are afraid and anxious, thinking, "Oh, will I have to have a major operation ?" But with the advanced medical technology available today, there are amazing ways to remove these things without making a big incision in the body. Today, we are going to talk about one such special, minimally invasive treatment method.
Simply put, what is Endoscopic Submucosal Dissection (ESD)?
This is very simple to understand. You've probably heard of an ' endoscopy ' test. A procedure where a flexible tube with a camera is inserted through the mouth or anus to examine the food pipe . This is the same thing. But it's a little more advanced.
In ESD, a gastroenterologist uses an endoscope to insert very fine surgical instruments. Then, the abnormal tissue in the wall of your digestive tract, the tumor -like part, is carefully cut out and removed. The best part is that all of this happens without making any incisions outside your body. This means there is less pain than after major surgery, and you can recover faster.
What types of conditions is the ESD method useful for?
This treatment is typically used to remove cancerous or precancerous growths, polyps , or lesions in the digestive tract. ESD is particularly effective for the following conditions:
- Barrett's esophagus: In this condition, the cells in the lower part of the esophagus change abnormally. These can later turn into cancer.
- Colorectal cancer
- Esophageal cancer
- Small intestine cancer
- Stomach cancer
Most importantly, this method can completely remove the cancer cells or abnormal tissue in one piece . This makes it easy to confirm whether the disease has been completely eliminated.
What is the difference between ESD and EMR?
You may have heard of another procedure called `Endoscopic Mucosal Resection (EMR).` Both of these procedures are minimally invasive treatments performed using an endoscope. However, there are some slight differences between the two. Let's take a look at what they are.
| Feature | Endoscopic Mucosal Resection (EMR) | Endoscopic Submucosal Dissection (ESD) |
|---|---|---|
| Target location | Tumors on the surface of the inner lining of the digestive tract (mucosa) are removed. | As well as the surface tumors, tumors that have gone a little deeper into the membrane can also be removed. |
| Method used | The tumor is removed by injecting a liquid under it, lifting it up, and cutting it with something like a metal snare. Sometimes it is removed in several pieces. | Using a special electric knife, the fruit is cut very finely around and underneath, removing it in one piece . |
| Most suitable occasions | For relatively small, superficial nuts. | For large, flat, or slightly ingrown tumors, especially in cases of cancerous tumors, complete removal is recommended. |
How do you prepare before treatment?
This doesn't require much preparation. Your doctor will give you the exact instructions you need.
- If the endoscope is being inserted through the mouth (e.g. stomach, esophagus): You will be asked to refrain from eating or drinking for a few hours before the treatment.
- If it is inserted rectally (e.g., into the colon): You will be asked to "bowel prep." This means that you will need to take a laxative that your doctor will prescribe to completely clean out your colon. This will allow the doctor to see the inside of your colon clearly.
What happens during treatment?
There is no need to worry about this. An anesthesiologist will either put you completely to sleep (`General Anesthesia`), or give you medication to keep you relaxed and pain-free. You will not feel anything during this time.
During treatment, the doctor will follow these steps:
1. The endoscope tube is inserted through the mouth or rectum.
2. Looking through the camera, go to where that unusual tumor is.
3. The location of the tumor is marked with a special device.
4. To avoid damaging the healthy tissue underneath the tumor, a special fluid is injected under the tumor. This creates a "cushion" underneath the tumor, lifting the tumor up.
5. Then, using a high-frequency electrical knife, the tumor is completely cut and removed.
This entire process can usually take about one to three hours.
What happens after treatment? And what are the risks?
After treatment, you will be monitored in a recovery room until you wake up from the anesthesia. The tissue removed is sent to a laboratory for diagnosis. There, a pathologist examines it to see if there are any cancer cells and whether all of the cancer has been removed.
You may be able to go home the same day, or you may have to stay in the hospital overnight. Most importantly, it takes about 24 hours for the effects of the anesthesia to wear off completely, so you will definitely need to come with someone and drive them home in a car.
There may be minor discomfort for a day or two after the treatment, but there are some things you should be aware of.
| Common, temporary side effects (recover in 1-2 days) | When to go to your doctor or the hospital's Emergency Department (ETU) immediately |
|---|---|
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|
Complications of ESD are rare, but they can include bleeding, gastrointestinal perforation, or esophageal strictures. These are very rare.
How long does it take to recover?
Most people can return to their normal activities after about 5 days. However, if you have a physically demanding job, your doctor may advise you to rest for a while. Your bowel movements may be a little irregular for about a week after treatment.
You will be asked to see the doctor again about two weeks after the treatment. Then you can discuss the results of the lab report and whether you need further treatment.
Take-Home Message
- Endoscopic Submucosal Dissection (ESD) is a highly advanced treatment method that removes early-stage cancers or abnormal tumors in the digestive system without making a large incision outside the body.
- This removes the abnormal tissue in one piece, making it easier to confirm that the disease has been completely removed.
- It is less painful than traditional surgery, the recovery is much quicker, and there are no major scars.
- Follow your doctor's instructions carefully before and after treatment.
- If you experience symptoms such as excessive bleeding, severe pain, fever, or difficulty breathing after treatment, notify your doctor immediately or go to the Emergency Department (ETU) of the nearest hospital.
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