What is ESD?
Endoscopic Submucosal Dissection (ESD) is an advanced endoscopic procedure used to remove gastrointestinal tumours that have not entered the muscle layer. Unlike conventional polypectomy or piecemeal EMR, ESD allows the endoscopist to remove even large or complex lesions in a single piece (en-bloc), providing more accurate pathological assessment and reducing the risk of recurrence.
ESD can be performed in the oesophagus, stomach, or colon, and has historically been a technique predominantly performed in Japan and other parts of Asia. A/Prof Kostalas trained in this technique with Prof Takashi Toyonaga, one of the world's leading ESD experts, and established the Mid North Coast's first ESD service.
Regional First
Large colonic polyps and early cancers which previously required surgical operations can often be removed endoscopically with ESD. This organ-preserving approach avoids the risks and recovery time associated with major surgery.
When is ESD recommended?
- Large flat or sessile polyps that cannot be safely removed by conventional polypectomy
- Early-stage cancers confined to the superficial layers of the GI tract
- Lesions where en-bloc (single-piece) removal is important for accurate pathology
- Recurrent lesions after previous incomplete endoscopic removal
- Complex lesions involving scarring or fibrosis
The Procedure
ESD is performed under general anaesthesia. A specialised endoscopic knife is used to carefully dissect the lesion from the underlying muscle layer, after injecting fluid into the submucosal space to create a safety cushion. The procedure typically takes longer than standard polypectomy due to the precision required, but allows complete removal in one piece.
Most patients stay in hospital overnight for observation following ESD. Recovery is generally much quicker than surgical alternatives, with most patients returning to normal activities within a few days.
Advantages over Surgery
- Organ preservation (no bowel resection required)
- Shorter hospital stay (typically overnight vs. days-weeks for surgery)
- Faster recovery and return to normal activities
- Lower complication rates compared to surgical resection
- Complete pathological assessment of the removed specimen
Videos
Watch examples of ESD procedures performed at Port Macquarie Gastroenterology:
View all videos on our YouTube channel →
The Port Macquarie ESD Course
A/Prof Kostalas founded the annual Port Macquarie ESD Course (PMEC) in collaboration with Prof Takashi Toyonaga, providing hands-on individualised training in ESD for Australian gastroenterologists. This course brings world-class ESD education to regional Australia.
Referral Information
If you have a patient with a complex polyp or early GI cancer that may be suitable for ESD, please refer to A/Prof Kostalas for assessment. Referrals can be sent to reception@portmacquariegastro.com.au or faxed to our rooms. Please include relevant endoscopy reports and histopathology.