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Endoscopic submucosal dissestion (ESD) is a procedure performed to remove the tumors from the gastrointestinal tract which have not yet entered the layers of the muscle. It is also a therapeutic endoscopic procedure useful for superficial gastrointestinal neoplasms. Endoscopic submucosal dissection is performed for various internal organs such as esophagus, stomach and colon.

Endoscopic submucosal dissestion is performed to remove the non-cancerous growths which are present on the lining of the colon or on the rectum. This procedure is also used to remove certain colorectal tumors. ESD is a minimally invasive procedure used for the treatment of colorectal cancer.


The endoscopic submucosal dissection is performed under general anesthesia. A long narrow tube is inserted into the stomach through the throat. It is also inserted into the colon through the anus. The tube is either inserted through the mouth or through the anus. The lesions are removed from the stomach and the colon.

ESD procedure consists of 3 steps. They are:

  • To observe the lesion clearly, the lesion is elevated by injecting a fluid into the submucosal layer.
  • The surrounding mucosa of the lesion is cut.
  • The submucosa present beneath the lesion is dissected.


The patient is advised to follow the below mentioned precautions:

  • A list of all the prescribed medications and a set of all relevant x-rays if any should be taken.
  • Consumption of alcohol should be stopped 24 hours before the procedure.
  • Inform the doctor about the medications taken such as Aspirin, Clopidogrel, Warfarin etc.
  • Diabetic and blood pressure patients carry their medications along with them.


Getting ready for the procedure

  • The patient is advised to wear loose fitting and comfortable clothes.
  • All the valuables should be left at home.
  • The doctor will provide the patient with all the required details of the procedure.
  • The patient will be given local anesthesia to numb the area through which the tube is inserted.

During the procedure

  • The patient will be asked to change into the hospital gown and the doctor will give the patient local anesthesia to numb the area.
  • A mouthpiece will be placed between your teeth to protect your mouth.
  • The patient will be asked to lie on the left side and the tube is inserted through the mouth.
  • A thin long flexible tube is inserted into the stomach through the mouth to observe the changes or abnormalities in the upper abdomen.
  • The procedure is performed under general or local anesthesia.
  • Endoscopic submucosal dissection is performed along with a small sample of the tissue to examine it under the microscope to check for the abnormalities in the affected area.
  • The endoscope does not interfere with the breathing of the patient.
  • The procedure takes about 20 minutes to complete.

After the procedure

  • The patient will be allowed to follow a regular diet right after the procedure.
  • The doctor will inform in case the patient has to follow any preventive measures.
  • The samples taken as biopsy will be sent to the laboratory for results.
  • The patient will be advised not to drink or smoke after the procedure.
  • The patient may feel uncomfortable and uneasy after the procedure but will come back to normal.
  • In case the patient experiences any of the symptoms such as fever, pain in the chest, pain in the abdomen, bleeding etc, should be immediately informed to the doctor.


The two most common complications associated with endoscopic submucosal dissection are:

  • Bleeding
  • Perforation

The other rare complications associated with endoscopic submucosal dissection are:

  • Aspiration
  • Pneumonia
  • Stenosis
  • Venous thromboembolism
  • Air embolism

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