Endoscopic Submucosal Dissection (ESD)

Endoscopic Submucosal Dissection (ESD) is an advanced endoscopic surgery for en bloc removing large colorectal lesions, which could not be removed en bloc safely with simple colonoscopic polypectomy. Using an endoscope and specially designed surgical instruments, the polyp is carefully dissected from the submucosal layer, allowing for complete en-bloc resection while without perforating the bowel wall.

The colon is composed of multiple tissue layers, with polyps typically arising from the innermost mucosal layer. ESD combines a special electrosurgical knife with endoscopic visualization, enabling the endoscopist to separate and fully remove the polyp from surrounding normal tissue, minimizing damage to the colon.

During the procedure, the endoscopist first marks the boundaries of the polyp.A solution is injected into the submucosal layer outside the marked area to lift the polyp. The specialized knife is then used to circumferentially cut and separate the polyp from underlying muscler layer. Additional injections beneath the polyp further elevate it, allowing gradual submucosal dissection to completely free the polyp.

Advantages of ESD include smaller wounds and faster recovery,compared to colectomy surgery.But this procedure requires a high level of technical skill and should only be performed by experienced endoscopists trained in ESD techniques.