Having an ESD
Endoscopic submucosal dissection for early cancers of the food pipe or stomach
An endoscopic submucosal dissection (ESD) is a procedure to remove pre-cancerous cells, or small areas of cancer in the food pipe (oesophagus) or tummy, without the need for major surgery.
This information will help you prepare for the procedure and to know what to expect when you come in to hospital.
Preparing for an ESD
To make sure the endoscopist has a clear view your stomach must be completely empty.
- Do not eat anything for 6 hours before your ESD.
- Do not drink anything for 4 hours before your ESD.
- You can have small sips of water for up to 2 hours before your ESD.
- Wear loose-fitting clothes on the day of the test.
If any of the below applies to you, you might need special instructions to prepare for your ESD. Please contact the nursing staff as soon as possible if you:
- are taking medicines to thin the blood or to prevent blood from clotting (anticoagulants or antiplatelets, such as warfarin, rivaroxaban or clopidogrel)
- have diabetes and are on insulin
- have allergies to any medicines
- are allergic to latex
Your usual medicines
Let your medical team know if you are taking any medicines. You can tell them at your pre-assessment appointment.
Let them know about any medicines you buy from a pharmacy or shop or any herbal or homeopathic medicines too.
Please bring all of your medicines into hospital with you. If you forget to bring them with you, let the team know exactly what you take.
More information on stopping any medicines will be given to you at your pre-assessment appointment.
Unless you are asked to make changes, please continue to take your medicines as prescribed. Do not make any changes to your usual medicines, or stop taking them, unless you have been asked to.
If you have questions about your medicines, please ask a pharmacist or a member of your medical team.
When you arrive at the endoscopy unit
When you arrive, you will book in at reception and take a seat in the waiting room.
We will ask you about your medical history. Please tell us if you have had any reactions or allergies to other examinations in the past.
We will also ask you to complete a health questionnaire which will help to speed up your admission or pre-assessment. This can be filled in on the day of your admission in reception.
Please be prepared to be with us for the whole morning or afternoon (depending on your appointment time).
Our endoscopists are usually running up to 5 procedure rooms at the same time, so sometimes another patient who arrived after you may be called in before you are. This does not mean you have been forgotten, but that the other person is on a different list to you. We do everything we can to avoid keeping you waiting and will keep you updated, but because every procedure takes a different time to complete, it’s hard to give exact timings.
We also deal with emergencies in the department. This means we might have to ask you to wait. We are sorry if this happens, but please be patient and check at the reception desk if you are concerned.
Your endoscopist (the doctor or nurse doing the procedure) will explain more about the procedure and answer any questions.
We may do an ECG which is a test to look at the health of your heart.
We may take some blood for tests.
Once you are ready you will be taken to a waiting area, called the sub wait area.
You might be asked to remove your shoes, loosen any tight clothing and remove any false teeth or glasses. You can change into a gown if you wish. You might want to bring your dressing gown and slippers with you (we do supply non-slip socks).
You will need to take off all your jewellery, so it’s best if you leave any valuables at home as we cannot be responsible for any valuables in the unit. You will need to keep your belongings with you at all times.
All metal needs to be removed as we use an instrument that uses an electrical current to stop any bleeding.
During the procedure
A thin flexible tube called a gastroscope or endoscope is passed through your nose and down the back of your throat and into your tummy. The tube will not get in the way of your breathing at any time as it passes down your food pipe, not your windpipe.
The full-thickness resection device (FTRD) is a cap which is placed on the end of endoscope and the abnormal cells are pulled in to it. The cap cuts the abnormal cells off and is then removed. A small clip is used to seal where the abnormal cells were located. The clip remains in your stomach or bowel and in time will come off and safely pass out into the toilet.
After the procedure
After the procedure you will be taken to the recovery area.
- You will need to rest quietly.
- The nurse will check your blood pressure and pulse, and will take you to the discharge area when you are stable.
If you are having this procedure done as a day case, we will tell you when you are well enough to leave.
You may need to stay in hospital overnight so that we can make sure that are well enough to go home.
You will need a responsible adult to escort you home and stay with you for the first 24 hours. If you do not organise an escort, or if they are under 18 years old, your procedure may be cancelled.
If you cannot arrange for someone to collect you and stay with you overnight, please contact us to discuss alternative arrangements.
Resource number 5354/VER1
Published date May 2023
Review date May 2026
