What is the benefit of endoscopic submucosal dissection?

Before describing the advantages of endoscopic submucosal dissection (ESD), let’s understand a few concepts:

Complete resection: The whole resected specimen is pathologically negative at the horizontal and vertical margins. In other words, the lesion is cut off intact.

Curative resection: complete resection with no or low risk of lymph node metastasis. That is, resection with little or no risk of cancer metastasis, allowing for a clinically curative outcome.

After understanding the above concepts, let’s look at what the efficacy assessment of ESD looks like:

The rates of whole resection and complete resection for ESD have been reported to be 90% to 100% and 87.9% to 97.4%, respectively; the 5-year survival rate after treatment is 100% for patients with lesions confined to the epithelium or mucosa; and the 5-year survival rate after ESD is 85% even when the lesion has invaded the submucosa.

It is easy to see from the data that ESD is very effective in treating early-stage esophageal cancer.

So, are the risks of ESD treatment significant?

The main risks of treatment with ESD include bleeding, perforation, and pain.

In the treatment of other cancers, such as stomach and colorectal cancer, bleeding is the most common complication, with intraoperative bleeding being more common.

But the incidence of all types of complications in ESD treatment of esophageal cancer is relatively low. Studies have shown that the perforation rate for esophageal ESD is 0% to 6%, the postoperative bleeding rate is almost 0%, and the local recurrence rate ranges from 0.9% to 1.2%.

For intraoperative bleeding, physicians can control it by endoscopic electrocoagulation or use of titanium clips; intraoperative and postoperative bleeding can also be effectively prevented by preoperative and postoperative application of hemostatic agents.

If perforation occurs, it is usually detected by the surgeon during surgery and can be managed at that time with titanium-clamp sutures and further treated postoperatively with a combination of gastrointestinal decompression, fasting, and prevention and control of infection. Surgical treatment may be required in only a few cases.

Also, post-ESD pain is mild and you can usually tolerate it.

In summary, ESD treatment is still very advantageous in the treatment of early-stage esophageal cancer

Minimally invasive treatment. It ensures that the tumor is completely removed while preserving the normal digestive tract to the greatest extent possible, and your quality of life is significantly improved. Because endoscopic treatment is less invasive and you tolerate it better, the hospital stay is short, and some people can go home the same day after treatment.

Complete resection. ESD can remove large, irregularly shaped tumors in one complete pass, significantly reducing tumor residual and recurrence.

Clear diagnosis.

Definitive diagnosis: ESD allows resection of the lesion without incision, obtaining complete biopsy specimens to determine the nature and extent of the tumor.

Increased efficiency.

Increased efficiency. The same patient can be treated multiple times with ESD, and multiple lesions can be removed at the same time with a single treatment.

Compared with endoscopic mucosal resection, EMR, another commonly used endoscopic treatment, ESD is a more advanced surgical technique with complete postoperative resection, allowing for complex early-stage cancer resection and generally no The situation of incomplete resection does not usually occur; however, the limitation is that it is a difficult surgery and requires a high level of skill and experience of the surgeon, and it is recommended that you better choose an experienced esophageal cancer center for treatment.

Co-written by:

Dr. Wang Police, Endoscopy Center, Peking University Cancer Hospital