✦ ADVANCED EN-BLOC ENDOSCOPIC SURGERY

Endoscopic Submucosal Dissection (ESD)

Q: How is ESD different from EMR?

ESD removes large lesions in one piece (en bloc), while EMR may need to remove larger lesions in pieces (piecemeal). En-bloc removal provides better pathology assessment and lower recurrence rates for select early cancers.

Q: Is ESD suitable for all early cancers?

ESD is reserved for early lesions limited to the mucosa, with no high-risk features, in carefully selected patients. Detailed pre-procedure assessment with high-resolution endoscopy and biopsy is essential.

Q: What if the biopsy shows deeper invasion?

If biopsy shows cancer with deeper invasion or high-risk features, additional surgery may be planned. Many early cancers limited to the mucosa are completely cured by ESD alone with no further treatment needed.

Q: Are there any risks with ESD?

ESD is technically demanding. Risks include bleeding (usually controlled endoscopically) and perforation (uncommon with experienced technique, often closed during the procedure). Most complications can be managed without surgery.

Highly advanced endoscopic technique to remove large early lesions in one piece (en bloc) — provides clean margins and detailed pathology for select early gastrointestinal cancers.

60–180 min PROCEDURE

1–2 Days HOSPITAL STAY

>90% SUCCESS RATE

1–2 Weeks RETURN TO ROUTINE

What is Endoscopic Submucosal Dissection (ESD)?

Endoscopic Submucosal Dissection (ESD) is a highly advanced endoscopic technique to remove large early gastrointestinal lesions and select early cancers in one piece (en bloc) during endoscopy. Specialised endoscopic knives are used to carefully dissect the lesion in the submucosal plane, allowing complete removal with clear margins and excellent pathology assessment. ESD is particularly valuable for early stomach, oesophageal, and rectal cancers, providing a true alternative to surgery in select patients. As an experienced proctologist in Hyderabad, Dr. Tejasree Vengala coordinates ESD at Lux Hospitals, Hyderabad, in close collaboration with advanced endoscopists.

Suitable for large early gastrointestinal lesions, select early cancers (limited to the mucosa) of the stomach, oesophagus, colon, or rectum where en-bloc removal is essential for accurate staging and complete cure.

How the Procedure Works

Bowel / Stomach Preparation

The relevant area is prepared — bowel cleansing for colonic ESD, fasting for upper GI ESD — to ensure clear visualisation.

Sedation & Endoscopy

The procedure is performed under sedation or general anaesthesia. The endoscope is inserted to clearly visualise the lesion.

Lesion Marking & Submucosal Injection

The lesion margin is marked with electrocautery, and a submucosal solution is injected to lift the lesion.

Circumferential Incision & Dissection

A specialised endoscopic knife makes a circumferential incision around the lesion, followed by careful submucosal dissection to remove it in one piece.

Specimen Retrieval & Closure

The lesion is retrieved en bloc for detailed biopsy. The base is inspected, any bleeding controlled, and closure clips applied if needed.

Outcomes

60–180 minDURATION

1–2 DaysHOSPITAL STAY

>90%SUCCESS RATE

2–3 WeeksFULL RECOVERY

Who Needs This Treatment?

→Removes large lesions in a single piece (en bloc)
→Provides clean margins and detailed pathology assessment
→Avoids surgery for select early cancers
→Preserves the entire organ — no bowel resection needed
→Quick return to routine in 1–2 weeks
→Curative for many early-stage gastrointestinal cancers

ESD is endoscopic surgery in the truest sense — taking out an early cancer in one piece, with clean margins, through the scope itself. For the right patient with the right lesion, it offers a complete cure without sacrificing a single centimetre of healthy organ.

— — Dr. Tejasree Vengala, Consultant Proctologist & Laparoscopic Surgeon, Lux Hospitals, Hyderabad

Common Questions

Frequently Asked Questions

How is ESD different from EMR?+

Is ESD suitable for all early cancers?+

What if the biopsy shows deeper invasion?+

Are there any risks with ESD?+

Not sure which treatment is right for you?

Book a consultation with Dr. Tejasree Vengala and get a personalised treatment plan.

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