Endoscopic Submucosal Dissection

What is endoscopic submucosal dissection?

Endoscopic submucosal dissection is a minimally invasive procedure to remove irregular tissue from your gastrointestinal (GI) tract. During the procedure, a gastroenterologist (doctor specializing in gastrointestinal diseases) uses a long, flexible tube with a camera called an endoscope. They insert the endoscope through your mouth or anus (butthole), depending on which part of your digestive tract they’re treating. Then they insert surgical tools through the endoscope to remove irregular tissue.

Endoscopic techniques allow your doctor to reach your GI tract without making any incisions. This approach means you recover faster and with less pain than after open surgery.

What does endoscopic submucosal dissection treat?

You usually have endoscopic submucosal dissection to remove precancerous or cancerous growths (lesions, polyps or tumors) in your digestive tract. Endoscopic submucosal dissection is typically used to treat:

• Barrett’s esophagus, which may cause precancerous lesions.
• Colorectal cancer.
• Esophageal cancer.
• Small intestine cancer, including duodenal cancer.
• Stomach cancer.

What is the difference between endoscopic submucosal dissection and endoscopic mucosal resection?

Endoscopic mucosal resection and endoscopic submucosal dissection are both minimally invasive procedures to treat your GI tract. But each targets a different part of your digestive tract.

• Endoscopic mucosal resection: Gastroenterologists use this procedure to treat tumors that grow in your mucosa, the inner membrane lining your GI tract. Endoscopic mucosal resection is when a provider uses a metal loop to cut away the lesion in combination with injecting fluid under the lesion.
• Endoscopic submucosal dissection: This procedure treats tumors that are on the mucosa and those that grow deeper into your mucosa. The aim of endoscopic submucosal dissection is to resect the lesion in a single piece.

What happens before endoscopic submucosal dissection?

You’ll receive specific instructions to prepare for endoscopic submucosal dissection. If your gastroenterologist is treating your upper GI tract (esophagus, stomach or small intestine), you’ll need to avoid eating or drinking for several hours before the procedure. If they’re treating your lower GI tract (large intestine, which includes your rectum and colon), you may need to perform a bowel prep.

Bowel prep involves taking laxatives to empty your colon. This allows your gastroenterologist to clearly see inside your colon and rectum.

What happens during endoscopic submucosal dissection?

You may receive general anesthesia to put you to sleep for the procedure, or for monitored anesthesia care, where your anesthesiologist keeps you comfortable and relaxed.

During endoscopic submucosal dissection, your gastroenterologist:

• Inserts the endoscope through your mouth (for upper GI procedures) or anus (for lower GI procedures).
• Guides the endoscope to the irregular growth.
• Threads a tool through the endoscope to mark the tumor location.
• Injects a special fluid beneath the tumor to help it separate and lift away from surrounding tissue.
• Uses a high-frequency electrical knife to remove the tumor.

How long does endoscopic submucosal dissection take?

Endoscopic submucosal dissection usually takes around one to three hours.

What happens after endoscopic submucosal dissection?

Your gastroenterologist sends a sample of the irregular tissue to a laboratory. A pathologist (doctor who specializes in studying body tissue) analyzes the tissue sample for signs of disease.

You move to a recovery room while the anesthesia wears off. You may return home the same day or stay in the hospital overnight. You’ll need someone to drive you home, as it can take up to 24 hours for the full effects of anesthesia to go away completely.

What are the side effects of endoscopic submucosal dissection?

Depending on the area treated, you may have some mild to moderate side effects for a day or two, including:

• Bloating.
• Cramping.
• Excessive gas and gas pain.
• Nausea or vomiting.
• Sore throat.

Having a small amount of blood in your stool isn’t uncommon, but it should stop within 24 hours. Call your gastroenterologist immediately if you have rectal bleeding or blood in your stool for longer than 24 hours after this procedure.

What are the benefits of endoscopic submucosal dissection?

Endoscopic submucosal dissection allows your gastroenterologist to remove GI tumors without making large incisions or removing part of your digestive tract. Compared to open surgery, endoscopic techniques offer multiple benefits, like:

• Less pain.
• Lower risk of complications.
• No scarring.
• Quicker recovery.

What are the risks or complications of endoscopic submucosal dissection?

Complications of endoscopic submucosal dissection are rare but may include:

• Bleeding.
• Gastrointestinal perforation.
• Scarring in your esophagus, which can lead to esophageal strictures.

How long does it take to recover from endoscopic submucosal dissection?

Most people return to work about five days after endoscopic submucosal dissection. You may need to wait longer if you have an active job. You may have irregular bowel movements for about a week after the procedure.

What is the success rate of endoscopic submucosal dissection?

Endoscopic submucosal dissection is a highly successful procedure. Some studies have shown that tumors grow back in only 1% of people who undergo the procedure.

What is the follow-up care after endoscopic submucosal dissection?

You’ll likely have a follow-up appointment with your gastroenterologist about two weeks after endoscopic submucosal dissection. Your gastroenterologist will discuss your results and whether you need further treatment.

When should I call my healthcare provider?

Call your gastroenterologist immediately if you notice any signs of complications after endoscopic submucosal dissection, including:

• Blood in your stool that’s more than just on the toilet paper.
• Chest pain.
• Dizziness or fainting.
• Fever or chills.
• Shortness of breath (dyspnea).
• Vomiting blood.

Is endoscopic submucosal dissection a major surgery?

Endoscopic submucosal dissection is a minimally invasive procedure. It doesn’t involve large incisions like you’d receive in a major open surgery.

A note from Cleveland Clinic

Endoscopic submucosal dissection is a minimally invasive procedure to remove irregular growths or tumors from the superficial layers of your digestive tract. It allows your gastroenterologist to remove tumors without making any incisions. Compared to open procedures, endoscopic procedures allow you to recover more quickly with less pain and a lower risk of complications.