Overview

If your doctor has found abnormal cells (dysplasia or pre-cancerous cells) in your food pipe (oesophagus) or stomach, they might recommend that you have an endoscopic muscosal resection (ESD).

An ESD removes pre-cancerous cells, or small areas of cancer, without the need for major surgery.

It removes abnormal cells during a procedure called a gastroscopy. It's likely that you have had a gastroscopy before, but please ask your medical team if you would like more information on this procedure. 

ESD is done in the hospital, but you can go home on the same day and do not need to stay in hospital overnight.

You will have sedation. A small needle will be inserted into your arm or hand and you will be given an injection through this. Sedation is a medicine that makes you feel relaxed and sleepy but does not make you sleep.

An ESD is a bit like a biopsy, but bigger and slightly deeper to remove the abnormal cells. Some of the surrounding normal cells might also be removed, to make sure the cell removal is complete.

Who can have an ESD

Not everyone can have an ESD. It might be offered to people:

• who have a very small area affected
• whose tissue is only showing early changes
• who are not suitable to have an operation to remove the cells

Your doctor will work out what the best treatment is for you, and only offer you an ESD if they are confident that the abnormal area or cancer has not spread.

If the abnormal area is large, it can be treated by having another ESD.

If the tissue removed during an ESD shows that the cell changes are more than were suspected, then you might need an operation called an oesophagectomy or gastrectomy.

Risks

Your doctor will discuss these risks with you before asking you to sign a consent form. 

• Bleeding. This is often minor, but can occasionally mean you need to go to hospital to control the bleeding. This happens in 1 out of every 100 people who have an ESD.
• Hole or tear (perforation) in your food pipe. This affects about 2 in every 100 people who have an ESD. You would need to go to hospital if this happens. Sometimes, surgery is needed to repair it.
• Pain. It is common to feel chest pain for up to a week after an ESD. Try using your usual pain medicine first. If this does not help, you can ask for a codeine tablet from a pharmacy.
• Scar tissue. This is a risk if a large area of tissue is removed. Scar tissue can narrow your food pipe or the outlet of your stomach, making it difficult and painful to swallow, or cause sickness. If this happens, contact your medical team. They will book you in for another gastroscopy so that the narrowing can be stretched. You might also have steroid treatment to help stop the scar tissue from forming.
• Damage to teeth. Occasionally this can happen by biting down too hard on the mouth piece needed to keep your mouth open during the procedure.

Other treatment options

The only other treatment to remove abnormal cells is an operation called an oesophagectomy or a gastrectomy.

This is where part of your oesophagus, including the area of abnormal cells, is removed.

This is a major operation. People who have this treatment usually need to stay in hospital for some time, including in the intensive care unit.

Due to the nature of the surgery, it can take months to recover fully.

ESD targets only a small area of tissue compared to an oesophagectomy, which removes a much larger section. 

If the abnormal cells have spread, they are more likely to be removed if you have an oesophagectomy. So for some people, surgery is still a better option.