Endoscopic submucosal dissection DD is a minimally invasive method to treat early gastrointestinal tract cancer and precancerous lesions with the same effect as surgery What is endoscopic submucosal dissection? Endoscopic submucosal dissection is a new technique developed from endoscopic mucosal resection, which is a mature technique and has gradually become an effective treatment for early cancer and precancerous lesions of the gastrointestinal tract in recent years. What are the main lesions that endoscopic submucosal dissection is applicable to? It is mainly applicable to early cancer or precancerous lesions of gastrointestinal tract, which are limited to mucosal layer or only superficial submucosal invasion, without local lymph nodes and distant metastasis. Clinically, ESD is often applied to the treatment of the following GI tract lesions: 1. GI polyps and various precancerous lesions, especially those with a diameter greater than 2 cm, are recommended for ESD treatment, which can excise the lesions completely at one time. 2. Early GI tract cancer, combined with pigment magnification endoscopy and ultrasound endoscopy to determine the extent and depth of infiltration of early cancer, and for submucosal layer confined to the mucosal layer and without lymph node metastasis For early stage cancer, ESD treatment can achieve the same radical effect as surgery.3. Submucosal tumors, such as smooth muscle tumors, mesenchymal tumors, lipomas, etc., which are determined to originate from the mucosal muscle layer and submucosal layer by ultrasonic endoscopy, can be completely stripped of the lesion by ESD treatment. In Japan, almost more than half of the early gastric and colorectal cancers are currently treated by ESD. What are the advantages of endoscopic submucosal dissection? ESD has the same purpose and similar approach as mucosal resection, but has the advantages of complete resection of larger lesions larger than 2 cm and has a lower recurrence rate. In the past, the treatment of early gastrointestinal cancer was mainly based on surgery, but it is very traumatic and the patient’s recovery is slow, and it often causes different degrees of dysfunction after removing the diseased organ. ESD can completely remove larger lesions at one time to avoid tumor residue and recurrence, and compared with traditional major gastrectomy or radical resection of early gastrointestinal cancer, ESD has less damage, lower cost, and faster postoperative recovery. Safety of endoscopic submucosal dissection Like other endoscopic treatments, ESD also has certain risks. The main complications are bleeding and perforation, with an incidence of about 5-8%. Intraoperative bleeding can be controlled by endoscopic electrocoagulation or the use of titanium clips, and the application of hemostatic drugs before and after surgery can effectively prevent intraoperative and postoperative bleeding; perforation complicated by ESD is usually small and can usually be detected intraoperatively, and can be cured by a combination of titanium clip sutures, postoperative gastrointestinal decompression, fasting, and prevention of infection. Only a few patients require surgical treatment. Even so, ESD is a simple, effective, and less invasive method of treating gastrointestinal lesions with efficacy comparable to that of surgery. Matters to be noted after endoscopic submucosal dissection Patients undergoing endoscopic submucosal dissection should fast for 1 to 2 days after surgery, with a liquid, easily digestible diet for 1 week, acid-suppressing drugs, mucosal protective agents, and prevention and control of infection. The presence of abdominal distension, abdominal pain, vomiting of blood, black stool, etc., and the occurrence of complications such as bleeding and perforation should be noted within 2 days after surgery. Gastroscopy should be reviewed electively within 2 months after surgery to understand the healing of the trauma and the residual of any lesions.