What is an Endoscopic Submucosal Dissection (ESD)?

An ESD is a minimally invasive procedure used to remove early-stage cancers or pre-cancerous growths from the stomach (gastric), oesophagus (food pipe), or colon (large bowel).

Instead of major surgery, ESD is done using a thin, flexible tube called an endoscope, which is passed through your mouth or bottom, depending on the location of the growth.

Why is ESD recommended?

ESD is used to treat:

• Early gastric cancer or dysplasia (stomach)
• Early oesophageal cancer or Barrett’s oesophagus with high-grade dysplasia
• Early colorectal cancer or large polyps

It can remove abnormal tissue in one piece, which helps ensure complete removal and accurate diagnosis, often avoiding the need for more invasive surgery.

How is the procedure done?

• You will receive sedation or general anaesthetic to keep you comfortable.
• A doctor inserts an endoscope and carefully lifts the abnormal area from the surrounding tissue.
• Using a small (1.5 – 2.0mm) endoscopic knife, they cut underneath the lesion to remove it entirely.
• The area is checked and treated to minimise bleeding or complications.

What are the benefits?

• Avoids major surgery
• Shorter hospital stay and quicker recovery
• Less pain and faster return to normal activities
• Precise removal with good outcomes for early-stage cancers

What are the risks?

Like all procedures, ESD carries some risks. These include:

• Bleeding (usually manageable during the procedure)
• Perforation (a small tear in the wall of the stomach, oesophagus, or colon, which may need treatment or surgery)
• Stricture (narrowing) – especially in the oesophagus, which may require further treatment
• Recurrence – rare but follow-up is important

What happens after the procedure?

• You may stay overnight in hospital for monitoring for complications (most common in the first 24 hours)
• You might need a temporary change in diet (e.g., soft or liquid foods).
• You’ll be monitored and have follow-up appointments to ensure healing and check that the cancer hasn’t returned.
• You may need repeat endoscopies as part of ongoing surveillance.

Frequently Asked Questions

Q: Will I need more treatment after ESD?
A: If the cancer was completely removed and hasn't spread, ESD may be the only treatment needed. Sometimes further surgery or therapy is recommended depending on the results.

Q: Is it painful?
A: Most people have mild discomfort or a sore throat/belly for a day or two. Pain is usually well controlled with medication.

Q: How long is recovery?
A: Most people return to normal activities within a few days, depending on the site treated.