ESD: Minimally Invasive Endoscopy for Early Colon Cancer

     Gastrointestinal polyps, especially in the large intestine, are a very common problem among Thais. If left untreated or diagnosed and treated in a timely manner, they can lead to serious conditions. Ramkhamhaeng Hospital would like to introduce you to ESD (Endoscopic Submucosal Dissection), a technique for endoscopic dissection beneath the mucosal layer, to prevent these polyps from developing into malignant tumors and colon cancer in the future.

A technology that helps remove large polyps and early-stage cancer without open abdominal surgery, with minimal pain and a rapid recovery.

ESD Technique

     ESD (Endoscopic Submucosal Dissection) is a treatment technology for removing large polyps and early-stage cancer without open abdominal surgery, resulting in minimal pain and quick recovery. The doctor inserts a thin tube equipped with a high-resolution camera at the tip through the mouth or anus to precisely remove polyps or early-stage cancer from the gastrointestinal tract wall, eliminating the need for open abdominal surgery.

This technique can be used to treat abnormalities in various parts of the gastrointestinal tract, including:
 

• Esophagus
• Stomach
• Small intestine
• Large intestine and rectum

Advantages of ESD Treatment

Doctors recommend the ESD method instead of traditional surgery because:
 

• No abdominal surgical scars: Since it is performed via gastrointestinal endoscopy, there are no external wounds on the body, reducing incision pain and lowering the risk of complications associated with major surgery.
• Complete tissue removal in one piece (En Bloc Resection): Large lesions can be completely removed in a single piece allowing doctors to send the specimen for detailed pathological examination of the tissue margins clearly This reduces the chance of recurrence and is extremely useful for planning precise future treatments.
• Preservation of original organs: There is no need to lose or remove parts of organs such as the intestines or stomach, ensuring patients maintain a good quality of life after treatment.
• Very fast recovery: Most patients stay in the hospital for only 1–3 days and can return to normal daily life within a few days.

Who is suitable for ESD treatment?

Doctors will consider ESD treatment for patients with the following indications:
 

• Large polyps measuring 2 centimeters or more, which are too large to be removed completely in one piece using standard instruments such as forceps or snare loops.
• Flat or laterally spreading tumors (LST - Laterally Spreading Tumor).
• Detection of abnormal cells (Dysplasia).
• Early-stage gastrointestinal cancer that has not invaded deeply.
• Certain subepithelial tumors.

ESD Treatment Procedure

The ESD procedure is performed under the close supervision of physicians and a multidisciplinary team
to ensure maximum safety and comfort for the patient, consisting of the following key steps:

• Preparation: The patient prepares similarly to a standard gastrointestinal endoscopy.
• Anesthesia: The patient receives sedatives or general anesthesia to sleep comfortably throughout the procedure.
• Lesion Assessment: The doctor inserts a high-resolution endoscope to thoroughly evaluate the location, size, and boundaries of the lesion.
• Marking and Lifting: The doctor marks the boundaries around the lesion, then injects a special solution into the submucosal layer to elevate the lesion and separate it from deeper tissue layers.
• Lesion Dissection: Using specialized instruments, the doctor carefully cuts and dissects the tissue layers to precisely remove the polyp or lesion entirely in one piece.
• Inspection and Closure: Hemostasis is performed and small wounds inside the digestive tract are closed (if necessary), leaving organs and the digestive tract intact with absolutely no external wounds.

Precautions and Post-ESD Self-Care

     Although this treatment has a very high safety rate, because the wound is located inside the intestinal wall which is only 2–3
millimeters thick, the procedure requires specialized techniques, precision, and the experience of a specialized physician
to minimize potential risks such as bleeding or bowel perforation.

Post-Treatment Guidelines

• Stay hospitalized for symptom observation for about 1–3 days.
• Eat soft, mild-tasting foods for about 1–2 weeks to allow the internal wound to heal properly.
• Avoid strenuous physical exertion and refrain from lifting heavy objects initially.
• Visit the doctor for regular follow-up appointments as scheduled.

Warning signs requiring immediate medical attention: If you experience severe abdominal pain, fever, or vomiting blood after the procedure, you should return to the hospital immediately without waiting for your appointment date.