Endoscopic Submucosal Dissection (ESD)
Gastric ESD
In Western Australia, the incidence of early gastric cancer has been steadily increasing in recent years. This rise reflects greater awareness among clinicians, better screening practices, and improved detection of subtle early lesions during high-quality endoscopy. Identifying these cancers at an early stage opens the door to minimally invasive, organ-preserving treatment options that avoid the need for major surgery.
Endoscopic Submucosal Dissection (ESD) is the preferred technique for removing early gastric cancers confined to the inner layers of the stomach wall. Using a specialised endoscope and precision instruments, the lesion is carefully dissected and removed in one piece (en bloc), allowing accurate pathological assessment and an excellent chance of complete cure without surgery. Compared to traditional surgery, gastric ESD offers shorter recovery times, no external scars, and preservation of normal stomach function—while maintaining outstanding oncological outcomes.
At Royal Perth Hospital, Dr Niroshan Muwanwella has performed over 75 gastric cancer resections using ESD, establishing one of the most extensive clinical experiences in Western Australia. His work demonstrates a strong commitment to expanding access to advanced endoscopic therapy and improving outcomes for patients diagnosed with early gastric cancer.
What to Expect During a Gastric ESD
Gastric ESD is performed under general anaesthesia. A flexible endoscope is gently passed through the mouth into the stomach, and the lesion is precisely lifted and dissected from the underlying tissue. The procedure typically takes between 60 and 120 minutes, depending on the size and location of the lesion. Most patients are admitted overnight for observation and can usually return to normal activities within a few days.
After the procedure, the resected specimen is sent for detailed microscopic analysis to confirm complete removal and rule out deeper invasion. Your doctor will discuss the results and any further management required. Follow-up endoscopy is usually recommended to ensure full healing and ongoing surveillance.
Oesophageal ESD
Oesophageal Endoscopic Submucosal Dissection (ESD) is a minimally invasive technique used to remove early-stage cancers and precancerous lesions of the oesophagus. These lesions are often associated with Barrett’s oesophagus, a condition where chronic acid reflux causes changes in the oesophageal lining that can occasionally progress to cancer.
By enabling precise, en-bloc resection of early neoplasia, ESD allows for complete removal while preserving the oesophagus and avoiding major surgery. This results in faster recovery, reduced risk, and maintenance of normal swallowing function. In experienced hands, oesophageal ESD provides curative outcomes for many patients who would otherwise require oesophagectomy.
What to Expect:
Oesophageal ESD is performed under general anaesthesia. The procedure usually takes 1–2 hours, and most patients are observed in hospital overnight. Temporary chest discomfort or mild difficulty swallowing may occur but typically resolves within days. Follow-up endoscopy and surveillance are essential to ensure healing and monitor for recurrence.
Rectal ESD
Colonic ESD is an advanced endoscopic procedure designed to remove large or complex polyps and early cancers of the colon that are unsuitable for standard polypectomy or EMR. By carefully dissecting beneath the lesion, ESD allows complete, single-piece removal, ensuring accurate pathology and reducing the risk of recurrence.
This technique can eliminate the need for segmental bowel resection in selected cases, offering a less invasive, organ-sparing alternative to surgery. It is particularly useful for flat or scarred lesions, recurrent polyps, and early cancers detected through screening colonoscopy.
What to Expect:
Colonic ESD is performed under sedation or anaesthesia. Procedure times vary depending on the size and location of the lesion (typically 1–2 hours). Most patients are monitored overnight and resume normal activities within a few days. Mild abdominal discomfort or bloating may occur temporarily. Follow-up colonoscopy is scheduled to confirm complete healing and to perform long-term surveillance.