Endoscopic Submucosal Dissection (ESD)

Endoscopic submucosal dissection (ESD) is a minimally invasive procedure to examine and remove growths from the lining of the gastrointestinal (GI) tract without surgery. For early-stage cancers of the esophagus, stomach and colon, an ESD may offer a cure.

At the University of Chicago Medicine Center for Endoscopic Research and Therapeutics (CERT), our interventional gastroenterologists are highly skilled in performing ESDs and helping patients — even those with larger cancerous growths — avoid surgery to remove part of their GI tract. An ESD may even help some people avoid having an ostomy.

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What is endoscopic submucosal dissection?

An ESD is a minimally invasive procedure in which a specially trained doctor uses an endoscope (small camera on a long, thin tube) to remove growths in the digestive tract. It can also be used to help stage early cancers or rule out cancer in suspicious growths.

An ESD is an evolution of an older technique called endoscopic mucosal resection (EMR), which has been performed for more than 15 years at UChicago Medicine. But unlike the older EMR procedure, an ESD can be used to remove larger growths in the GI tract in one piece. This makes it easier for a pathologist to accurately determine if a growth is cancerous.

Who is a good candidate for an ESD?

An ESD may be an option for you if you have:

• Barrett’s esophagus with early cancer
• Superficial esophageal squamous cell cancer
• Early stomach cancer
• Early colorectal cancer
• Some types of colon polyps (especially large rectal polyps, which have a higher chance of being cancerous)

Typically, the best candidates for an ESD are patients who have or may have early cancers in their esophagus, stomach or colon, or who have certain types of benign (non-cancerous) polyps that cannot be treated during a regular colonoscopy.

What is the difference between endoscopic mucosal resections vs. endoscopic submucosal dissections?

Both EMRs and ESDs are advanced, minimally invasive procedures that use endoscopic tools to remove growths in the digestive tract. The main difference is that doctors use different surgical instruments during the procedures.

During an EMR, a doctor uses a tool called a snare, which is an instrument with a wire loop attached on the end. It can be used to remove small polyps and growths.

During an ESD, a doctor uses a very precise electrosurgical knife that can be used to remove larger, “flatter” growths in the digestive tract and help with cutting through scarred tissue. With this instrument, a doctor can also remove growths that may be deeper in the lining of the GI tract, which can provide more accurate staging if cancer is suspected.

Both procedures require specialized endoscopic expertise, but only a select group of centers have the experience to perform ESDs, which are more difficult to perform than EMRs.