What does it consist of?
The Tunnelled Endoscopic Submucosal Dissection (TESD) This is an advanced technique that allows the removal of tumours or lesions located in the deep layers of the digestive tract using a precise and minimally invasive endoscopic approach, without the need for open surgery.
This approach is especially useful in submucosal lesions, such as certain tumours of the oesophagus or stomach, which cannot be treated with more superficial techniques. It allows us to reach the lesion, remove it precisely, and preserve the integrity of the digestive wall.
Its main advantage is that it offers a Minimally invasive alternative to surgery, reducing the aggressiveness of the procedure and favouring a faster recovery, maintaining a high level of diagnostic and therapeutic precision.
What is the procedure?
The Tunnelled endoscopic submucosal dissection It is a technically highly complex procedure that is carried out in three main phases:
1. Preparatory steps
- Fasting The patient must undergo a strict fasting period.
- Medication The temporary suspension of anticoagulant or antiplatelet drugs is evaluated.
- Anesthesia Due to its long duration and the precision required, it is carried out under General anaesthetic in an operating theatre or equipped room, ensuring complete patient relaxation and optimal conditions for the doctor.
2. Tunneling
- Tunnel construction An incision is made in the mucosa approximately 4-5 cm from the lesion. Through this, the endoscopist dissects the submucosal layer, creating a «third space» or virtual tunnel to reach the tumour.
- Lesion dissection Once at the subepithelial lesion, it is carefully dissected from its surrounding muscle or submucosal layer using a metal-tipped micro-scalpel.
- Extraction The lesion is extracted with special forceps through the tunnel and removed via the mouth.
3. Completion and closure
Clip closure: The entrance hole of the tunnel is completely sealed with metal clips. This allows the area where the tumour was to be protected and contained within the organ's wall itself.
Specific instructions
The RSET is particularly indicated for subepithelial lesions (those that grow under the mucosa) less than 3-4 cm, such as:
Leiomyomas and GISTs Frequent in the oesophagus and stomach.
Neuroendocrine Tumours And granular cell tumours.
Other injuries Schwannomas, fibroid tumours or ectopic pancreas.
Symptomatic Cases Injuries that cause Difficulty swallowing (dysphagia) due to its size in the oesophagus.
Recovery and care
Following the intervention, the care protocol within GASTEA Madrid ensure controlled evolution
Hospital admission A minimum income is programmed 24 to 48 hours for surveillance.
Post-Operative Diet The patient is to remain nil by mouth for the first 24 hours. Subsequently, a liquid diet is commenced (24-48h) and then advanced to a soft diet.
Medication Prophylactic oral antibiotics are usually prescribed for 3 to 5 days.
Activity Reintegration into normal life is almost immediate after discharge, although it is recommended not to travel abroad or to areas far from a hospital during the first few weeks. 2 weeks.
Tracking
Histological Analysis The block specimen is analysed by the pathologist using immunohistochemical techniques to determine the exact nature of the lesion and its cellular activity.
Scar Management The bed where the lesion was located is monitored to ensure it heals correctly without complications.
Deferred surveillance The patient should remain vigilant for potential late complications, although clipping the tunnel drastically reduces these risks.
Results
The RSET has revolutionised the treatment of deep-seated tumours with excellent results:
- Proven effectiveness: Rates of complete and en bloc resection exceeding 95%.
- Minimum recurrence: The risk of the injury recurring is less than 11%–30%.
- Conservation of integrityUnlike open surgery, this technique preserves the integrity of the digestive wall and the organ's structure.
- Advanced SecurityTunnel sealing with clips minimises the risk of perforation and delayed bleeding, offering a minimally invasive alternative with a much faster and less aggressive recovery than conventional surgery.
Why carry out this test at GASTEA?
- High specialisation in advanced techniques. We perform STER/RSET with experience in complex endoscopy.
- Alternative to surgery. It allows for the treatment of deep injuries without the need for surgical intervention.
- Precise and conservative approach. Access to the lesion while preserving the organ's structure.
- Expert medical leadership. Procedure performed by specialists in advanced endoscopic resection.
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
In submucosal lesions of the oesophagus or stomach that cannot be treated with more superficial techniques.
Yes. In many cases, it avoids the need for more aggressive surgical intervention.
Yes, although it requires high specialisation and experience in advanced endoscopy.
It allows for less invasive treatment of deep injuries with better organ preservation.
- 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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