Recovery after an ESD

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.  

Follow this guidance to help you recover at home after the procedure.

When you leave hospital

A doctor will check you to make sure you are well enough to leave, which will be at least 1 to 2 hours after your procedure.

You must arrange to have a relative or friend (over 18 years old) to take you home and stay with you overnight. 

You will need to rest at home and avoid strenuous activity for a few days after your procedure.

The effects of general anaesthetic lasts longer than you may think.

Diet

• You should have cool liquids only and no hot drinks for 24 hours.
• Have a soft or sloppy diet for 2 days, such as smooth soups, yoghurt, porridge or scrambled eggs.
• Do not have foods that have a high temperature.
• After 2 days you can try a normal diet, but avoid meat and dry foods (such as toast, biscuits and crackers) for another 2 to 4 days.

Medicine

Take the strong acid-suppression medicines (omeprazole, lansoprazole, pantoprazole, rabeprazole or esomeprazole) as prescribed for at least 2 months.

Tell us immediately if you are not taking any of these medicines.

You should be taking these medicines 2 times each day, at least 30 minutes before you have breakfast and your evening meal. 

You might benefit from taking an antacid, such as Peptac®, Maalox® or liquid Gaviscon Advance. These can be bought at any pharmacy and some supermarkets. Avoid taking them before or within 30 minutes of your acid suppression medicines. 

• Do not take aspirin or NSAIDs (non-steroidal anti-inflammatory medicines), such as ibuprofen, Neurofen®, Voltarol®, diclofenac or naproxen, for 7 days after your ESD.
• Before you leave hospital, check with the endoscopist for instructions for taking anti-platelet or anticoagulant medicines. 
• You can take your usual medicines, but take plenty of water when swallowing tablets.

If you need care for a digestive issue in the 6 months after your ESD, from any medical team other than the doctors at St Thomas’ Hospital, please contact the endoscopy unit before starting any treatment.

Pain

It is common to have these side effects for 7 to 10 days after an ESD:

• chest tightness or discomfort
• mild discomfort with eating, particularly hot or solid foods, but it will help if you chew your food thoroughly before swallowing

You can use soluble paracetamol or co-codamol if you are uncomfortable.

You can use an anti-sickness medicine if you feel sick or are being sick. These can be bought from any pharmacy.

If you have any bloating or tummy (abdominal) discomfort, this might be from the air that was put in by the endoscopist during the examination. This is normal, and should settle within 24 hours. 

Peppermint tea can help relieve the trapped air.

Your results

We will discuss your procedure with you before you leave hospital. We will give you a copy of your report so that you understand the outcome from the procedure and any next steps.

The sample of the food pipe or stomach lining removed is sent to a laboratory for examination. We will get the results up to 2 weeks later and will call you to discuss the findings. 

The results determines what happens next.

• You may be invited to have a reassessment and biopsy of the ESD site in 3 months’ time. 
• You may be offered further endoscopic therapy to the ESD site.

Follow-up appointment

The upper gastrointestinal clinical nurse specialist (CNS) will contact you 24 to 48 hours after your procedure to check on your symptoms and recovery.

You might already have a follow-up outpatient appointment. If not, this will be posted out to you for the next available clinic.

If it is urgent, you will be given your appointment on the same day.

Useful information

GUTS UK is a charity that offers information, support and research into diseases of the digestive tract that includes the gut, liver and pancreas.