Endoscopic Submucosal Dissection (ESD)

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What is Endoscopic Submucosal Dissection?

Endoscopic submucosal dissection is a specialized treatment technique performed during an upper endoscopy or colonoscopy to remove precancerous, cancerous or other abnormal lesions from the lining of the gastrointestinal tract.

It is performed while you are under sedation, and you’ll likely go home the same day as your procedure. Endoscopic submucosal dissection is a less invasive alternative to surgical removal of lesions and allows your physician to determine how deep the diseased cells have reached into tissues beneath the lining of the gastrointestinal tract.

Endoscopic submucosal dissection requires skill and experience. Board-certified and fellowship-trained gastroenterologists at Norton Healthcare Gastroenterology have been performing the procedure in Louisville and Southern Indiana for years.

During either an upper endoscopy or colonoscopy, your physician will identify the lesion and determine how to remove it.

Typically, the endoscopic submucosal dissection requires four steps:

  1. Marking the lesion
  2. Injecting fluid into the submucosa (the middle wall layer of the gastrointestinal tract) to push the lesion and surrounding tissue up from the submucosa
  3. Incision around the lesion
  4. Dissecting the lesion from the middle layer underneath the lesion

The lesion is retrieved and analyzed in the laboratory. The advantage is more accurate assessment to help determine next steps.

How to Prepare for an Endoscopic Submucosal Dissection

Your physician will provide you with instructions you will need to follow in the days before your procedure. Following these instructions is essential to limit surgery risks and provide the best results.

Make sure your providers are aware of all medications that you are taking, especially the following:

  • Plavix (clopidogrel)
  • Effient (prasugrel)
  • Brilinta (ticagrelor)
  • Ticlid (ticlopidine)
  • Coumadin (warfarin)
  • Eliquis (apixaban)
  • Aggrenox (aspirin/dipyridamole)
  • Pradaxa (dabigatran)
  • Persantine (dipyridamole)
  • Xarelto (rivaroxaban)

We will advise you to discontinue or adjust your dosage of these medications. We may have you consult with your primary care physician or cardiologist prior to your procedure. Also let us know of any allergies to medications.

If you are using insulin, the dosage or timing will also need to be adjusted the day of the procedure.

Do not eat eating anything after midnight before your procedure is scheduled.

For endoscopic submucosal dissection by colonoscopy, your cleansing routine or prep will start the day before your procedure. A laxative will prepare your bowels and is the most important part of your preparation. Following the instructions and having a good cleanse can decrease the need for a repeat colonoscopy.

Once you’ve recovered from the sedation, your physician will provide a preliminary report. Any biopsy results may take several days.

Because of heavy sedation during the procedure, patients are instructed not to drive, operate machinery or make important decisions for 24 hours. The nursing staff will review all of the instructions before you leave the hospital. Someone needs to be available to drive you home.

After the procedure, you can drink clear liquids and then start with a bland diet.

Contact your physician if you notice severe abdominal pain, fever and chills, or excessive rectal bleeding or black stools.

If you are unable to keep your appointment or need to reschedule, call our office at (502) 896-4711 at least 48 hours prior to your procedure.

If you are going to be late for your procedure, call the hospital’s endoscopy department. If you are scheduled at Norton Women’s & Children’s Hospital, call (502) 893-1277. If you are scheduled at Norton Brownsboro Hospital, call (502) 446-8200.

About Norton Healthcare Gastroenterology

  • Norton Cancer Institute has nine outpatient locations and multiple infusion centers in Louisville and surrounding counties and Southern Indiana. We have three radiation centers located just off major interstates, with free, self-service parking and valet parking.
  • Our gastrointestinal cancer patient navigator guides you through the treatment process. The navigator is a registered nurse and advocate for patients and families who can help coordinate scheduling to minimize your visits. The navigator provides information and support throughout your diagnosis, treatment and beyond.
  • The Norton Cancer Institute multidisciplinary approach to cancer care means you’ll have access to multiple specialists, including medical oncologists, radiation oncologists, surgical oncologists, interventional radiologists, interventional gastroenterologists, researchers, geneticists and dietitians.
  • We pull together providers from various disciplines to help identify the best treatment for you. At Norton Cancer Institute review boards, you will be considered for innovative clinical trials, immunotherapy, minimally invasive procedures, state-of-the-art radiation and advanced diagnostics.

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