How long does an endoscopic esophagectomy for esophageal cancer take? What do I and my family need to do during this time? This is probably one of your more important concerns before treatment.
How long does the endoscopic resection procedure last?
The duration of the procedure is related to the size of the lesion and the complexity of the lesion. It can usually be done in 1-2 hours, with a maximum of 5 hours.
What does the surgeon do during the endoscopic resection procedure?
In an endoscopic submucosal dissection (ESD), for example, there are about 6 steps in the treatment process.
- Determine the extent and depth of the lesion. First, endoscopy is performed to understand the site, size, and morphology of the lesion, combined with staining and magnification endoscopy to determine the extent, nature, and depth of infiltration of the lesion.
- Labeling. After determining the extent of the lesion, electrocoagulation marking was performed approximately 3 to 5 mm from the edge of the lesion.
- Submucosal injection. A multipoint submucosal injection is performed lateral to the marker site at the lesion margin. The injection fluid includes saline, glycerol fructose, and sodium hyaluronate. The purpose is to lift the lesion and separate it from the muscularis, which facilitates complete resection of the lesion and does not easily damage the intrinsic muscularis and reduces the occurrence of complications such as perforation and bleeding.
- Excision. A portion of the mucosa surrounding the lesion is first incised along the marker point or the lateral edge of the marker point, and then the entire surrounding mucosa is incised deeper into the submucosa at the incision site.
- Submucosal dissection. Before performing the dissection, the surgeon will determine the elevation of the lesion and select the appropriate treatment endoscope and attachment.
- Wound management. After lesion debridement, the physician performs prophylactic hemostasis of all visible vessels on the trabecular surface; treatment such as hemostatic clamp closure, argon plasma coagulation (APC), etc., is performed on areas of potential bleeding.
What are the risks that occur during resection?
Some intraoperative complications, such as bleeding, may occur during ESD surgery.
Bleeding is possible at every stage of surgery, with the highest risk of bleeding at the time of incision. The surgeon will promptly treat it with hemostatic forceps or metal clips; or he will flush the wound with iced saline to clarify the bleeding point and then perform electrocoagulation to stop it. The surgeon will also perform prophylactic hemostasis of exposed vessels during the procedure.
Perforation is also a possible complication, and the surgeon will continue to peel the lesion after suturing the fissure with a metal clip.
What do I and my family need to do during treatment?
During treatment, you will need to remain in the supine position and then just cooperate with your doctor’s instructions.
Anesthesia is usually given during endoscopic treatment, so you won’t feel any discomfort, as if you slept. However, there is an extremely rare situation where the anesthesiologist assesses that you are not a candidate for anesthesia, such as an allergy to anesthetics or a serious underlying medical condition. In this case, you will need to undergo the procedure while awake and may experience discomfort such as nausea, bloating, burning sensation, and pain. We hope you will cooperate with the treatment as much as possible and not to move your head and body casually. If you cannot tolerate it, you should promptly indicate to your doctor.
During the procedure, family members will need to wait outside the operating room so that the doctor can communicate with them at any time if there are any special circumstances during the procedure.
Co-written by:
Wang Police, Endoscopy Center, Peking University Cancer Hospital