ESD - Endoscopic Submucosal Dissection (Colon)

• An infusion will be placed in the room and you will be asked to remove your glasses/contact lenses and dental prosthesis. A patient apron will be ready to wear.
• Female patients will be asked to take off their bra.
• You must be sober at least 6 hours before the exam. This means no eating, drinking or smoking.
• Just like a bowel exam, the intestine should be completely empty. You will therefore have to drink a specific laxative beforehand. (see also info about bowel research)

• This examination takes place in the endoscopy department under general anesthesia. If this has not happened in the room yet, the nurse will puncture a vein in the arm so that the anaesthetist can administer the anaesthetic.
• The anaesthetist sometimes places a tube in the airway to take over breathing.
• During the examination, you will lie on your left side or on your back.
• During the study, the oxygen level in the blood is continuously measured. This is done with a measuring device that is placed on the finger. You will also receive oxygen glasses on the nose.
• In some cases, a preventative dose of antibiotics is administered during the procedure.

The treatment

With the endoscope, the abnormality is well defined and the anomaly is marked all around and can then be completely removed by a large margin. Then, using a thin needle, a liquid is injected between the muscle layer and the layer to be removed in order to work safely. An incision is made around the injury with a very fine electric knife. Then, with the fine blade, the injury to be removed is completely detached from the muscle layer. Finally, the wound is carefully inspected and all blood vessels are cauterized with electrical current to prevent bleeding. The duration of the treatment varies depending on the size and localization of the injury: between 60 and 180 minutes. The removed injury is recovered and forwarded for microscopic examination afterwards.

• After the examination, you will be brought to the awakening room of the endoscopy department. There, the oxygen level in the blood is further monitored.
• You may also have bloating due to the carbon dioxide that was blown in during the study. Farming up or letting go can offer rapid improvement.
• After this procedure, you will usually be admitted for one or two nights.
• After the procedure, you can usually start a low-residue diet quickly, which is often extended to a normal diet fairly quickly.
• In case of high fever, unsustainable pain or anal bleeding, you should contact the department or doctor who treated you.

Bleeding

The treatment can affect a blood vessel. During the procedure, this is normal and can almost always be stopped. Late bleeding between the first and 14th days is possible; this is due to loss of blood through the stool. If this happens, a new endoscopy should be done to stop the bleeding. Late bleeding may occur in approximately 5 percent of the procedures.

Perforation

This creates a hole in the muscle layer so that there is a free gap between the treated organ and the abdominal cavity. This complication is rare and can occur in approximately 4 percent of the procedures. In this case, antibiotics should be administered and an attempt is usually made to close the hole endoscopically.

Stenosis

During the healing process, this causes a narrowing of the treated organ so that there is no longer a good passage of the stool. This complication is very rare and can almost always be solved by stretching the constriction open with a balloon.