Lesions and colon polyps are one of Gastrointestinal disease problems commonly found in Thai people. If they are left without diagnosis, some can result from abnormal proliferation of cells to cancer. Besides the severity of the disease, surgery is also a primary concern for patients. However, with a very advanced development, there is a new Endoscope technology to examine any anomalies of digestive system which does not only screen thoroughly but also be able to dissect large colon polyps without operation.
What is ESD Technique?
Endoscopic Submucosal Dissection (ESD) is a technique to insert endoscopes to remove large polyps from colons or stomach. It’s suitable for large lesions (>2 cm). This technique can cut polyps straightaway without open abdominal surgery. It is extremely accurate for the growth dissection per time which helps patients recover faster, often with less pain and without scar.
Which syndromes ESD is appropriate for?
In majority, ESD can use for colorectal lesions occurred in any parts of the digestive system such as esophagus, small intestine or large intestine mostly found in Thai people. Before ESD procedure, gastroenterologists will examine by endoscopy to check the position and size of the lesions to ensure that the treatment is the most accurate and safe. If a tumor is found as a malignant polyp with minimal risk, doctors will use ESD to remove and take a biopsy in order to plan the further treatment.
Advantages of the treatment by ESD Technique.
- Be able to cut large polyps from 2 cm onwards
- Be able to use endoscopes to dissect polyps promptly for biopsy without open abdominal surgery for patients.
- Be the best performance of dissection and able to remove the largest polyps per time which is different from other tumor removals as follows.
- Forceps: To use them to grasp a target tissue not over 3mm instantly during laparoscopic surgery
- Snare: To use it to capture a target tissue performed by Endoscopic Mucosal Resection (EMR) and be able to remove polyp with 1-2 cm length but cannot do it within one time.
- Be appropriate for patients with a risk of cancer as it can dissect a large tissue per time for biopsy. It is useful for the treatment plan in the future if it develops to a cancer cell.
- Reduce the risks from surgery and help patients less pain and recover faster.
Cautions in treatment
- The procedure is difficult and time consuming as it requires a high degree of thoroughness and accuracy.
- There’s a possibility of intestine perforation 5-6% due to the cut of many layers beneath to Submucosal. Therefore, a Gastrointestinal Endoscopy specialist is required.
Reasons to choose ESD procedure much more than surgery
Even though there are some risks in ESD procedure but it is worth more than a surgery. If patients choose an open abdominal operation…and the result is non-cancerous tumor, they still have to spend a very long time to recover after surgery.
Furthermore, if they leave tumors untreated by ESD and find later that some lesions deeply to Submucosa or polyps have already become cancerous cells, ESD procedure will not be appropriate for this patient group as they have to get the operation for cancer treatment anyway.
Dr. Varayu Prachayakul
Gastrointestinal Endoscopy Specialist
Gastrointestinal and Liver Diseases Center
Phyathai 2 Hospital, 4th Floor, Building A
Tel. 02-617-2444 ext. 7401, 7406
Appointment
