How is ESD Performed?

Step-by-Step Procedure

1. Patient is given:
   • Deep sedation or
   • General anesthesia
2. Endoscope is inserted:
   • Through mouth for upper GI lesions
   • Through anus for colon/rectal lesions
3. Lesion is examined carefully.
4. Borders are marked.
5. Special fluid is injected beneath lesion to lift it away from deeper muscle.
6. A specialized electric knife dissects beneath the lesion.
7. Entire lesion is removed in one piece.
8. Bleeding vessels are coagulated.
9. Clips may be applied if needed.
10. Specimen is sent for histopathology.

Duration of Procedure

• Usually 1–4 hours
• Complex lesions may take longer

Is ESD Painful?

No. The procedure is done under sedation or anesthesia, so patients generally do not feel pain during the procedure.

Afterwards, mild symptoms may occur:

• Gas
• Bloating
• Cramping
• Mild throat discomfort
• Mild abdominal pain

Usually manageable with medicines.

Hospital Stay

Depends on lesion size and location.

Small/Simple ESD

• Same-day discharge possible

Large or Difficult ESD

• 1–3 days hospital observation

Recovery After ESD

First Few Days

• Soft or liquid diet
• Avoid spicy/heavy foods
• Rest

Recovery Timeline

• Most patients recover within:
  • Few days to 1 week

Follow-up

• Histopathology report review
• Repeat endoscopy/colonoscopy may be needed

Advantages of ESD

Organ-Preserving

Avoids removing part of stomach or colon in many patients.

Minimally Invasive

No external cuts or stitches.

Better Cancer Assessment

Lesion removed in one piece gives accurate pathology.

Lower Recurrence

Less chance lesion grows back.

Faster Recovery

Compared to surgery.

Risks and Complications

Though generally safe in expert hands, complications can occur:

Bleeding

Most common complication.

Perforation

Small hole in intestine/stomach wall may occur.

Infection

Stricture/Narrowing

Especially in esophageal ESD.

Need for Surgery

Rarely if complication occurs or cancer is deeper than expected.

Warning Signs After ESD

Seek urgent medical help if you develop:

• Severe abdominal pain
• Fever
• Vomiting blood
• Black stools
• Heavy rectal bleeding
• Breathlessness
• Persistent vomiting

Success Rate

ESD has very high success rates when performed by experienced specialists. Studies show very low recurrence when lesion is completely removed in one piece.

Real Patient Experiences

Many patients describe:

• Procedure longer than routine endoscopy/colonoscopy
• Mild throat discomfort or bloating afterwards
• Recovery over several days
• Relief when surgery is avoided

Some large rectal or colon ESD procedures may require general anesthesia and temporary clips/sutures.

When to Consult a Gastroenterologist for ESD Evaluation?

If reports show:

• Large flat polyp
• Early GI cancer
• Dysplasia
• Non-lifting lesion
• Recurrent polyp after previous removal

A specialist in advanced therapeutic endoscopy can determine whether ESD, EMR, or surgery is best.