ESD - Endoscopic Submucosal Dissection (Esophagus/Stomach)

• An infusion will be placed in the room and you will be asked to remove your glasses/contact lenses and dental prosthesis. A patient apron will be ready to wear.
• Female patients will be asked to take off their bra.
• You must be sober at least 6 hours before the exam. This means no eating, drinking or smoking.

• This examination takes place in the endoscopy department under general anesthesia. If this has not happened in the room yet, the nurse will puncture a vein in the arm so that the anaesthetist can administer the anaesthetic.
• The anaesthetist often places a tube in the airway to prevent breathing problems.
• During the examination, you lie on the left side with a mouthpiece between the teeth/lips to avoid biting the endoscope.
• During the study, the oxygen level in the blood is continuously measured. This is done with a measuring device that is placed on the finger. You will also receive oxygen glasses on the nose.
• In some cases, a preventative dose of antibiotics is administered during the procedure.

The treatment

With the endoscope, the abnormality is well defined and the anomaly is marked all around and can then be completely removed by a large margin. Then, using a thin needle, a liquid is injected between the muscle layer and the layer to be removed in order to work safely. An incision is made around the injury with a very fine electric knife. Then, with the fine blade, the injury to be removed is completely detached from the muscle layer. Finally, the wound is carefully inspected and all blood vessels are cauterized with electrical current to prevent bleeding. The duration of the treatment varies depending on the size and localization of the injury: between 60 and 180 minutes. The removed injury is kept for microscopic examination afterwards.

• After the examination, you will be taken to the awakening room of the endoscopy department. There, the oxygen level in the blood is further monitored.
• A raw feeling in the throat is possible for some time. Pain in the chest and/or stomach in the first few days is also possible.
• You may also have bloating due to the carbon dioxide that was blown in during the examination. Farming up or letting go can offer rapid improvement.
• After this procedure, you will sometimes be admitted for a short time.
• On the day of the procedure, you should only take water. In principle, you can start with liquid food from the second day. Then gradually switch to soft food and from the tenth day you can eat normally.
• In case of high fever, unsustainable pain, inability to swallow or loss of blood (vomiting or anal bleeding), you should contact the department or doctor who treated you.

Bleeding

The treatment can affect a blood vessel. During the procedure, this is normal and can almost always be stopped. Late bleeding between the first and 14th days is possible; this is due to vomiting or loss of blood through the stool. If this happens, a new endoscopy is needed to stop the bleeding. Late bleeding can occur in approximately 5 percent of the procedures.

Perforation

This creates a hole in the muscle layer so that there is a free gap between the treated organ and the abdominal or chest cavity. This complication is rare and can occur in approximately 4 percent of the procedures. In this case, antibiotics are administered and attempts are usually made to close the hole back.

Stenosis

During the healing process, this causes a narrowing of the treated organ so that there is no longer a good passage of the food. This complication is very rare and can almost always be solved by stretching the constriction open with a balloon.