Endoscopic Submucosal Dissection 

Endoscopic submucosal dissection (ESD) is a procedure to remove tumors from the gastrointestinal (GI) tract. It is done under general anesthesia and is done mostly on outpatient basis.

 It is done using a high-definition upper GI endoscope either through the mouth or anus (depending on location of the tumor). An electrosurgical knife used to cut the tumor from the adjacent tissue with the use of high-frequency electrical current. 

The knife also aids in cauterizing any bleed during the procedure. The tissue which is excised is then sent for histopathological examination.

It is indicated in: -

 1. Early-stage cancer of the GI tract (especially esophagus) 

2. Polyps

 3. Non-invasive tumors of the stomach or large intestine 

4. Pre-malignant diseases like Barrett’s

Special note: -

 a) Because it is special minimally invasive procedure, the organ of involvement is preserved. This helps maintain quality of life for the patient

 b) Since the lesion is completely removed, this procedure is almost curative for early cancers. 

c) Low recurrence rates and better quality of life compared to more invasive procedures for the same pathology 

d) Better management of disease (early cancer) established since entire tumor resected. This allows for detailed histopathological examination and more accurate staging of disease.