Depending on the size, location and complexity of the polyp, the endoscopist may opt for a classic polyp resection with snare, for endoscopic submucosal dissection (ESD) or for piecemeal endoscopic mucosal resection (EMR).

The choice for ESD or EMR is always taken in consultation with your attending physician and after consideration of many factors.

Endoscopic submucosal dissection (ESD)

To remove larger polyps or cancer in an early stage, endoscopic submucosal dissection (ESD) may be chosen. This can be used for abnormalities in the oesophagus, stomach as well as intestines.

The technique was developed in the early 1990s in Japan. It consists of cutting the abnormality from the mucous membrane using a tiny electric knife, separating it from the underlying muscle layer. For this technique, fluid is injected in the space between the mucosa and the muscle layer to widen it. This ensures that the procedure can be done more safely and faster.

The important benefit of ESD is that the polyp can always be submitted to the anatomical pathologist in one piece. This allows for a very detailed diagnosis so that subsequently, correct follow-up can be offered to the patient.
At the same time, the risk of local recurrences is reduced, as the abnormality has been removed en bloc. This is especially important in case of suspected high-grade dysplasia or carcinoma. This way, surgery can be avoided for a significant percentage of patients.

Indications for ESD include polyps in the oesophagus, stomach or intestines from 20 mm which are suspected of turning malignant. This malignancy must be in a very early stage (maximum T1 tumour). An experienced endoscopist can estimate the stage based on the surface characteristics of the polyp.

Additionally, ESD can also be a safe option for resection of polyps with major submucosal fibrosis (scarring), for instance, in the context of polyp recurrence after previous polypectomy or in the context of IBD.

Centres and specialist areas

Digestive Centre

Latest publication date: 05/02/2021
Supervising author: Dr Vanderstraeten Erik