Endoscopic Submucosal Dissection (ESD)

Indications | Outcomes | Pre-procedure Preparations | Procedures | Post-procedure Instructions | Advices on discharge | Possible Risks and Complications

Endoscopic Submucosal Dissection (ESD) is an advanced endoscopic procedure used to remove superficial gastrointestinal neoplasms which not yet infiltrate to the muscle layer. ESD has been applied to esophageal and colorectal neoplasms with favorable short-term results. This procedure consists of three steps which include injecting fluid into the submucosal layer to elevate the lesion, cutting the surrounding mucosa of the lesion and dissecting the submucosa beneath the lesion.


  • Early gastric cancer
  • Early esophageal cancer
  • Early colorectal cancer
  • Larger polyp
  • Submucosal lesion


The expected outcome of this procedure is determined on different indications. The aim of this surgical procedure is to remove neoplasms which embedded only in submucosal layers of the involved organs in order to prevent the risk of morbidity.

Pre-procedure Preparations

  • The procedure and possible complications will be explained by the doctor and a consent form must be signed prior to the procedure.
  • No food or drinks six hours before operation.
  • Oral bowel preparation is needed if ESD is performed in the colon.
  • You should inform the doctor if you have any medical conditions (e.g. diabetes mellitus, heart disease, hypertension etc.) and taking any regular medications (e.g. Aspirin, Warfarin, Plavix, Xarelto, Dabigatran including herbs and dietary supplement).
  • Please change into a surgical gown after removing all clothing including undergarments, dentures, jewellery and contact lenses.
  • Please empty your bladder before the operation.


  • The procedure can be performed under general or local anaesthesia, sedative or anesthetic drugs may be given as prescribed by the doctor;
  • You will lie on your left side;
  • Doctor will pass an endoscope through the throat, anus or bladder into the position of lesion;
  • It is normal to experience abdominal bloating;
  • A fluid is injected into the submucosa to elevate the lesion.
  • The surrounding mucosa of the lesion is removed.
  • The submucosa beneath the lesion is dissected.

Post-procedure Instructions

  • Follow the instruction by the surgeon, eating can be usually resumed on the next or day after ESD if there is no complication occurs.
  • Antacids are usually administered to gastric and esophageal ESD patients to relieve pain, prevent postoperative bleeding and promote ulcer healing.
  • You may be discharged within a few days.

Advices on discharge

  • You should immediately return to the doctor or hospital for professional attention in the event of servere pain, massive bleeding, shivering, fever over 38℃ or 100℉ etc.
  • Any follow-up consultations should be attended as scheduled.

Possible Risks and Complications

  • Bleeding
  • Perforation
  • Pain
  • Infection
  • Failure to remove all of the lesions completely