Endoscopic Submucosal Dissection (ESD) for Esophageal and Gastric Cancer

Overview

What is endoscopic submucosal dissection (ESD)?

Endoscopic submucosal dissection (ESD) is a minimally invasive procedure that removes cancer from the gastrointestinal tract of a patient without removing the organ involved. This allows the patient to maintain quality of life.

The gastrointestinal tract is the passageway through which food travels from the mouth to the anus, and includes the esophagus (the “food tube”), stomach, small bowel and colon.

What are esophageal and gastric cancers?

Esophageal and gastric cancer are conditions in which malignant (cancerous) tumors develop through a series of changes (dysplasia) in the cells of the esophagus or stomach. Treatments include ESD, surgery, brachytherapy radiation, chemotherapy, and combination therapy (radiation and chemotherapy).

Procedure Details

How is endoscopic submucosal dissection (ESD) used to treat esophageal and gastric cancer?

The ESD procedure is performed with an endoscope, a long, thin, flexible instrument about 1/2 inch in diameter. The endoscope is passed through the patient’s mouth. Through the endoscope, instruments are used to precisely dissect (cut) the tumor, and the tumor is removed in one piece through the patient’s mouth.

This is how the ESD procedure for esophageal cancer is performed:

  • The patient is given general anesthesia and sleeps during the procedure.
  • The endoscope is passed through the patient’s mouth.
  • The cancerous lesion is highlighted with a stain so that it stands out from the healthy tissue.
  • The surgeon marks the margins of the tumor (the area surrounding the tumor) to make sure all of the tumor is removed.
  • The surgeon injects a liquid into the submucosal layer beneath the lesion to lift it and make it easier to remove. (The submucosa is the layer of tissue just below the mucous membrane.)
  • The surgeon then dissects the lesion and removes it through the patient’s mouth.

Risks / Benefits

What are the advantages of endoscopic submucosal dissection (ESD) for esophageal and gastric cancer?

The advantages of ESD for the treatment of esophageal and gastric cancer include the following:

  • The surgeon is able to remove the entire tumor in one complete piece.
  • The native organ (esophagus, stomach) is left in place, allowing a patient to maintain his or her quality of life.
  • Because the surgeon takes the surrounding tissue, it can be examined to determine if all of the cancer has been completely removed.
  • ESD is considered a cure for early esophageal and gastric cancer, as long as the cancer has not spread through the lymph nodes to other parts of the body.
  • Patients who have ESD for esophageal and gastric cancer have a low recurrence (return) rate (the cancer rarely comes back).

What are the side effects of endoscopic submucosal dissection (ESD) for esophageal cancer?

The side effects of ESD include bleeding, perforation (tearing) of the esophagus or stomach and stricture (narrowing) of the esophagus or stomach.

Recovery and Outlook

What is the prognosis (outlook) for patients who have an endoscopic submucosal dissection (ESD) procedure for esophageal cancer?

If the cancer is found and treated while it is in an early stage, the prognosis for patients is very good. In one study, the five-year survival rate (the percentage of patients still alive five years after the procedure) was 95 percent.

Last reviewed by a Cleveland Clinic medical professional on 02/27/2019.

References

  • Bhatt A, Abe S. Indications and Techniques for Endoscopic Submucosal Dissection. Am J Gastroenterol 2015 Jun;110(6):784-91.
  • Mejía-Pérez LK, Abe S. A minimally invasive treatment for early GI cancers. Cleve Clin J Med 2017 Sep;84(9):707-717.
  • Mehta N, Strong AT. Optimal injection solution for endoscopic submucosal dissection: A randomized controlled trial of Western solutions in a porcine model. Dig Endosc. 2018 May;30(3):347-353
  • Aadam M, Abe S. Endoscopic submucosal dissection for superficial esophageal cancer. Diseases of the Esophagus, Volume 31, Issue 7, 1 July 2018, doy021, https://doi.org/10.1093/dote/doy021
  • National Cancer Institute. Esophageal Cancer Treatment (PDQ®)–Patient Version. Accessed 3/4/2019.
  • Seewald, S., Ang, T.L., Pouw, R.E. et al. Management of Early-Stage Adenocarcinoma of the Esophagus: Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection. Dig Dis Sci (2018) 63: 2146. https://doi.org/10.1007/s10620-018-5158-5

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