What does it consist of?
The Endoscopic Submucosal Dissection (ESD) It is an advanced technique that allows precise and minimally invasive removal of lesions in the digestive tract, without the need for surgery. It is performed via endoscopy, accessing the submucosal layer to remove block lesions.
It is recommended in early or superficial injuries, such as certain complex polyps or early-stage neoplasms, where a complete and well-defined resection is important. This allows for effective treatment and, in many cases, the possibility of opting for less invasive alternatives.
Its main advantage is that it combines diagnosis and treatment in a single procedure, also allowing a Detailed analysis of the excised lesion to confirm the diagnosis and define the appropriate follow-up.
What is the procedure?
The Endoscopic submucosal dissection It is a meticulous process that is divided into three key phases to ensure patient safety:
1. Preparatory steps
Fast cleansings: The patient must undergo a minimum fasting period. In the case of colon and rectal interventions, a bowel preparation similar to that for a colonoscopy is completed.
Medication Adjustment If the patient is taking antiplatelets or anticoagulants, temporary suspension may be necessary before the procedure to minimise bleeding risks.
Surgical Environment It is usually performed in an operating theatre or an endoscopy suite equipped for General anaesthesia or prolonged deep sedation, ensuring optimal working conditions and patient well-being.
2. Dissection Technique
Circumferential Cut: Using a micro-scalpel with a metallic tip (1-2 mm) introduced via the endoscope, the specialist makes an incision around the lesion to a specific depth of the wall.
Injury Disconnection A “dissection” or horizontal cut is made through the middle layer (submucosa) to detach the lesion from the deeper layers of the wall.
3. Extraction and closure
Block Extraction The lesion is removed in one complete piece through the mouth or anus (depending on its location).
On-site treatment During the procedure, haemostatic forceps are used to control bleeding points and, if necessary, metallic clips are used to treat any immediate complications. A residual ulcer will remain at the site of the lesion, which will heal spontaneously.
Specific instructions
This procedure is indicated for the treatment of early-stage neoplastic lesions with a high probability of complete cure.
Oesophagus Squamous cell carcinoma (early stage, any size) and adenocarcinoma (early stage, size >1-2 cm).
Stomach Early-stage gastric cancer.
Colon and Rectum Early-stage cancer on a polyp or polyps of large size (>4 cm) with difficulty of removal by standard techniques.
Complex Cases: Scarring from previous failed attempts, flat-depressed forms, or growth over inflammatory bowel disease.
Submucosal Injuries Layer injuries using the technique of Tunneled DSE (RSTE).
Recovery and care
Following the procedure, a strict monitoring protocol is followed:
Hospital admission A minimum income is programmed 24 to 48 hours for monitoring of possible complications and to keep the patient on absolute diet for the first few hours.
Return to normal life Discharge is usually given after this period if there are no complications, allowing for an almost immediate return to activity, with diet progression at home.
Restrictions It is not recommended to travel abroad or to remote rural areas far from a hospital until after 2 weeks of the intervention.
Tracking
Histological Analysis The excised piece is fixed to a plate for the pathologist to perform a detailed analysis. This will determine if the excision has been curative or if further treatment is required.
Stenosis Control In extensive interventions (especially involving the oesophagus), the patient requires regular endoscopic follow-ups to treat potential strictures by balloon dilation.
Active Surveillance. The patient should be vigilant for signs of delayed bleeding (black stools or vomiting blood) during the healing process of the residual ulcer.
Results
- Effectiveness: Cure rates exceeding 95% in early-stage neoplasms and polyps. Efficacy: Cure rates exceeding 95% in early-stage neoplasms and polyps.
- Minimum recurrence: The risk of recurrence is less than 1%, significantly lower than with other techniques involving excision in sections.
- Organ preservation: In many cases, it avoids radical surgery, eliminating the risks and permanent consequences of removing parts of the oesophagus, stomach, or rectum.
Why carry out this test at GASTEA?
- Advanced endoscopy reference. Technique performed by specialists with extensive experience in complex endoscopic resection.
- Alternative to surgery. In many cases, it allows injuries to be treated without the need for surgical intervention.
- Precise and complete resection. It allows for the en bloc removal of lesions, improving diagnosis and disease control.
- Specialist medical leadership. Procedure performed under the direction of Dr. Alberto Herreros, a key figure in these types of techniques.
And GASTEIZ, safety is our priority. During the informational consultation, our specialists will explain the safety profile of the procedure in detail and resolve all your questions in a personalised manner.
Preguntas frecuentes
Yes. In many cases it allows injuries to be treated without the need for surgical intervention.
Yes, although being more complex, it must be carried out by experienced specialists.
In most cases, yes, as it allows for en bloc resection.
Greater precision, better injury analysis, and less invasiveness than surgery.
- Full and personalised clinical assessment. Detailed analysis of symptoms, history, and previous tests to understand your case in depth.
- Clear diagnostic guidance. Definition of the following steps, necessary tests and the most suitable approach from the outset.
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