Gastroenterology - Endoscopic Submucosal Dissection (ESD) in the upper gastrointestinal tract (food pipe/ stomach)

What is this leaflet for?

This leaflet explains a treatment called Endoscopic Submucosal Dissection (ESD).

You may need this treatment if doctors have found early signs of cancer or unusual cells in your food pipe (oesophagus) or stomach.

It helps you understand the treatment and what to expect before you sign the consent form.

What are early cancer and abnormal cells?

Some people have a higher chance of getting cancer in the food pipe or stomach. This might be because of health problems like Barrett’s oesophagus or chronic gastritis.

Doctors check people with these conditions by doing regular endoscopies (camera tests). Sometimes they find early cancer (which has not spread) or abnormal cells (called dysplasia), which could turn into cancer later.

Why do I need ESD?

You might have been given this leaflet because doctors found early cancer or abnormal cells in your food pipe or stomach.

The ESD treatment can remove these cells and might stop you needing other treatments like surgery, chemotherapy, or radiotherapy.

What is Barrett’s Oesophagus?

Barrett’s oesophagus happens when acid from the stomach damages the food pipe over time. It can sometimes turn into cancer.

People with Barrett’s have regular checks to catch any changes early.

What is ESD?

ESD is a way of removing the bad cells from your food pipe or stomach. Doctors use a thin, bendy camera (called an endoscope) and a tiny knife to cut out the area with bad cells.

The piece they remove is sent to a lab to check it properly.

How many treatments will I need?

Usually, only one ESD is needed. You will have another camera test in 3–6 months to check how you're healing.

If you have Barrett’s oesophagus, you might need other treatments called ablation therapy to help stop the condition coming back.

What can I do to help the treatment work?

• You will need to take tablets that stop acid in your stomach (like omeprazole)
• You might get extra medicines for a few weeks to help healing
• Don’t smoke, don’t drink too much alcohol, and eat well to help your body heal

What happens before the ESD?

• You’ll meet with a doctor who will explain the treatment and risks
• The team will check if you’re well enough to have a general anaesthetic (medicine that puts you to sleep)
• You’ll need to stop eating for a while before the test
• You may need to stop blood-thinning medicine
• Bring someone to take you home and stay with you for 24 hours after the test 
• You may stay overnight if needed

What happens during the ESD?

• You’ll meet the nurses, doctors, and anaesthetist (the doctor who gives you the sleep medicine)
• They’ll ask about your health and take blood tests
• You’ll be put to sleep with medicine
• The doctor will do the treatment with a small camera inside your food pipe or stomach
• If needed, they might also stretch tight areas (called dilatation)
• You’ll wake up after the procedure and a doctor will explain how it went

Will it hurt?

The test itself shouldn’t hurt because you’ll be asleep.

Some people feel sore or uncomfortable after, but this usually goes away with normal painkillers.

What happens after the ESD?

• You’ll stay for a few hours after the test to make sure you’re okay
• Some people stay overnight
• You’ll get medicine to help stop acid in your stomach
• You’ll be given a follow-up appointment in 3–6 months

Are there any risks?

General risks:

• Sore throat
• Bloating or wind
• Bleeding
• Small chance of a hole (called perforation)
• Damage to teeth (dentures are taken out)

ESD-specific risks:

• Pain: usually mild, but if it’s very bad or doesn’t go away, call for help
• Scarring: sometimes the food pipe can become narrow. Doctors can fix this by stretching it
• Bleeding (2-5/100): may happen during or after the test. Watch for black poo or being sick with blood
• Perforation (2-5/100): rare, but if it happens you may need admission to hospital, a feeding tube, or even surgery in very rare cases
• Anaesthetic risks: like chest infection, heart problems, or allergic reactions. These are rare

After you go home

Eating and drinking:

• Nothing to eat or drink for a few hours
• Then clear drinks, followed by soft foods for 5–7 days
• If your swallowing gets worse after 2 weeks, contact the hospital

Get help straight away if you have:

• A high temperature
• Black poo or blood when being sick
• Chest pain
• Swelling in the neck or chest

What happens next?

• You’ll get your results in about 3–4 weeks
• If all looks good, you’ll have check-ups every few months
• If you have Barrett’s, you might get another treatment to stop it coming back

If you have any questions at any time you may contact:

• Kerry Quinn our Upper GI clinical nurse specialist on 07873 704349 or
• The secretaries involved in your care - 0161 206 5671