Endoscopic Submucosal Dissection for Early Gastric Cancer

Introduction:

Gastric cancer, or stomach cancer, begins in the stomach cells. The stomach is present in the upper abdomen, which helps digest food. Gastric cancer occurs when the cells in the stomach lining grow and divide uncontrollably, forming a mass of abnormal tissue called a tumor. Over time, cancer can spread to nearby organs and tissues and other body parts through the bloodstream or lymphatic system.

There are several types of gastric cancer, each classified based on the type of cell from which the cancer originated. Adenocarcinoma is the most common type of gastric cancer. Endoscopic submucosal dissection is a minimally invasive endoscopic procedure used to remove early gastric cancer (EGC) from the stomach lining. EGC is cancer confined to the mucosal layer of the stomach, and ESD is an effective treatment option for patients with EGC.

What Are the Pre-Operative Preparations for Endoscopic Submucosal Dissection?

Endoscopic submucosal dissection is an effective treatment for early gastric cancer and some precancerous lesions and non-cancerous tumors in the stomach. ESD is typically indicated in the following situations:

• Early Gastric Cancer: ESD is considered the standard treatment for EGC that has not spread beyond the mucosal layer of the stomach. ESD can remove the cancerous tissue while preserving the rest of the stomach, providing a good chance of a complete cure and avoiding more invasive surgery.

• Precancerous Lesions: ESD can also be used to remove precancerous lesions in the stomach, such as gastric adenomas or dysplasia (a type of stomach cancer). These lesions can develop into gastric cancer if left untreated, so ESD can help prevent cancer development by removing the abnormal tissue.

• Non-Cancerous Tumors: ESD can also remove non-cancerous tumors in the stomach, including gastrointestinal stromal tumors (GISTs) or leiomyomas. These tumors can cause symptoms or complications if they grow or bleed, and ESD can help to remove them while preserving the rest of the stomach.

• Medication Management: Before ESD, patients may need to stop taking certain medications that can increase the chances of bleeding, including blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs). Patients should follow the healthcare provider's instructions for medication management.

• Fasting: Patients must fast for a certain period before the ESD procedure, typically for at least 6 hours or as directed by their healthcare provider. Fasting helps to reduce the risk of complications during the procedure, such as vomiting or aspiration.

• Bowel Preparation: Patients may need to undergo bowel preparation before ESD to ensure the stomach is empty and clean. This can help improve the procedure's accuracy and reduce the risk of complications. Bowel preparation may involve a liquid diet and laxatives or enemas.

• Anesthesia: ESD is typically performed under general anesthesia, which means that patients will avoid eating or drinking before the procedure to lessen the risk of anesthesia complications.

• Blood Tests: Patients may need to undergo blood tests before ESD to check for any abnormalities that may increase the risk of complications during or after the procedure.

• Consent: Patients must provide informed consent before undergoing ESD, which involves a detailed discussion with their healthcare provider about the procedure's risks, benefits, and potential complications.

What Is the Procedure of Endoscopic Submucosal Dissection?

Endoscopic submucosal dissection is a specialized procedure performed by a skilled gastroenterologist or endoscopist. The following are the steps involved in the ESD procedure:

• Anesthesia: The patient is placed under general anesthesia to ensure they are comfortable and free from pain during the procedure.

• Endoscopy: The endoscope is a thin, flexible tube with a light and camera attached, inserted through the mouth and into the stomach. The camera provides real-time images of the inside of the stomach, allowing the gastroenterologist to view the lesion that needs to be removed.

• Marking: Once the lesion is identified, the gastroenterologist will use a special dye or ink to mark the area around the lesion that needs removal.

• Submucosal Injection: A special fluid is injected into the submucosal layer of the stomach to help separate the lesion from the surrounding tissue, making it easier to remove.

• Dissection: Using specialized tools inserted through the endoscope, the gastroenterologist will carefully dissect and remove the lesion without damaging surrounding tissue or organs.

• Hemostasis: Once the lesion is removed, the gastroenterologist will use special techniques to stop bleeding and seal the wound.

• Recovery: After the procedure, the patient will be taken to a recovery area where they will be monitored for complications. Most patients may go home on the same day as the procedure, although some may need to stay overnight for observation.

What Are Post-operative Care Tips for Endoscopic Submucosal Dissection?

After endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), postoperative care is crucial for proper healing and minimizing the chances of complications. The following are some general guidelines for postoperative care:

• Recovery Period: Patients need to stay in the hospital for some days after the procedure to be monitored for any complications and to ensure they are stable. The duration of hospitalization will depend on the size and location of the removed lesion.

• Pain Management: Patients may experience discomfort or pain after the procedure, which can typically be managed with pain medication prescribed by their healthcare provider.

• Diet and Nutrition: In the days following ESD, patients may need to follow a special diet to allow the stomach to heal properly. This may include avoiding solid foods and sticking to a liquid or soft diet for some time.

• Follow-up Appointments: Patients must attend regular follow-up appointments with the healthcare provider to monitor their recovery and ensure that the EGC has been completely removed. These appointments may involve endoscopic examinations to check the site of the ESD for any signs of recurrence or complications.

• Activity Restrictions: Patients may need to avoid certain activities, including heavy lifting or strenuous exercise, for a while after the procedure to allow their bodies to heal fully.

• Complication Management: Although ESD is generally safe and effective, there is a small risk of complications, such as bleeding or infection. Patients should be aware of the signs and symptoms of these complications and seek medical attention if they occur.

What Are the Benefits of Endoscopic Submucosal Dissection?

The following are the benefits of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC).

• Higher cure rates compared to other treatments.

• Less invasive than traditional surgery.

• Lower risk of complications.

• Shorter hospital stays.

• Quicker recovery times.

• Preserves the stomach and its functions.

• It can be repeated if necessary.

• Allows for accurate staging and diagnosis.

• This can avoid the need for more invasive surgeries.

What Are the Disadvantages of Endoscopic Submucosal Dissection?

The following are the disadvantages of endoscopic submucosal dissection for early gastric cancer:

• Technical expertise is required.

• Risk of complications such as bleeding and perforation.

• Not suitable for larger or more advanced tumors.

• Higher cost compared to other treatments.

• Longer procedure time compared to other treatments.

• Need for specialized equipment and facilities.

• The potential need for repeat procedures or additional treatments.

• Risk of incomplete removal or recurrence of the cancer.

• Difficulty in accessing lesions located in certain areas of the stomach.

Conclusion:

Endoscopic submucosal dissection is a promising technique for treating early gastric cancer, offering several advantages over traditional surgery. ESD has high success rates and lower morbidity and can preserve the stomach and its functions. However, specialized expertise and equipment are required, and there is a risk of complications. With proper patient selection and careful consideration of the risks and benefits, ESD can be a valuable treatment option for eligible patients with early-stage gastric cancer.