ESD: Japanese Treatment for Colon Polyps Catching On Here?


NEW YORK CITY, N.Y. (Ivanhoe Newswire) — Almost half of all adults in the U.S. develop colon polyps during their lifetime, growths that are often benign, but sometimes develop into cancer.  Now, one doctor at Mt. Sinai hospital in New York is advocating a procedure developed in Japan for removing and testing some of them.

Fifty-year-old Jaime Reid is bouncing back from a health scare that could have set him back for weeks. During a routine colonoscopy, doctors found a polyp.

While most mushroom-like polyps are removed endoscopically with a surgical tool that snares the growth, Reid’s polyp was too large and flat. The traditional option would have been to remove that section of the colon.

“It would have meant another five days in the hospital. Probably a week out of work,” Reid said.

Instead, Reid had a procedure called ESD or endoscopic submucosal dissection. Using an endoscope, doctors inject fluid into the layer of the bowel next to the polyp-creating a working space. Then doctors use the scope to deliver an electric current, like a laser.

“The scope is being used to actually draw around the lesion and cut layer by layer to get the polyps removed,” said Richard Whelan, MD, a colorectal surgeon at Mt. Sinai.

(Read Full Interview)

Dr. Whelan is one of only a handful of surgeons and GI doctors performing ESD in the United States. He says doctors need more training, and hospitals will need to invest in specialized equipment before ESD can catch on.

For Reid, ESD meant only one day in the hospital.

“I was at work four days later. That’s a success for me,” Reid said.

Dr. Whelan says Japan is about 15 years ahead of the United States in treating colon polyps with advanced endoscopy in part, because Japanese surgeons have more experience using ESD to treat stomach cancer, which is more prevalent in that country.

Contributors to this news report include: Cyndy McGrath, Field and Supervising Producer; Kirk Manson, Videographer; Hayley Hudson, Assistant Producer; Roque Correa, Editor.

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REPORT: MB #4508

 BACKGROUND: A colon polyp is a small clump of cells on the lining of the colon. Most are harmless; however, over time some can develop into colon cancer. This form of colon cancer can often be fatal when found in its later stages. The two main types of polyps are non-neoplastic and neoplastic. Non-neoplastic polyps typically do not become cancerous. In general the larger the polyp the greater risk, particularly with neoplastic polyps. Anyone can develop colon polyps, but you are at a higher risk at 50 years or older, if you are a smoker, overweight, or if you have a family/personal history of colon polyps/colon cancer. Oftentimes there are no symptoms associated with colon polyps. It is therefore important to have regular screenings. Colon polyps found in the earliest stages can normally be removed completely and safely.


POLYP REMOVAL: Most polyps found through colonoscopy can be completely removed during the procedure. There are various removal options available, most of which involve removing them using a wire loop biopsy forceps and/or burning the base of the polyp with an electric current; this is a procedure  known as polyp resection. Because the lining of the bowel is not sensitive to cutting or burning, resection does not cause discomfort. If a large or unusual looking polyp is left behind for possible surgical management later on, the endoscopist may mark the site with a small amount of sterile India ink or carbon black into the bowel wall. If it is deemed necessary the polyp must be removed, the traditional surgical option will be to have a section of the colon removed, better known as a colectomy. This procedure can carry some serious risk of complications, including but not limited to; bleeding, blood clots, infection, tears, and injury to organs near the colon.


NEW TECHNOLOGY: Endoscopic submucosal dissection or ESD is an outpatient procedure to remove deep tumors from the gastrointestinal tract. Specially trained doctors use flexible, tube-like imaging tools called endoscopes to perform ESD. Most patients go home the same day after treatment. Only a few select centers across the United States perform ESD because the procedure requires a high degree of training and expertise. Often recovery is faster and less painful than with laparoscopic or open surgical procedures. An endoscope is inserted into the anus, and once the polyp is located, your doctor will observe the images on the screen and mark its border with a special tool passed through the endoscope. The layer beneath is then injected with a solution to lift it away from the muscle wall; this is done to minimize damage to surrounding tissue during the procedure. An electrosurgical knife with a high-frequency electrical current is then used to cut the tumor tissue free from the GI wall. The electrical current stops any active bleeding; the tissue is then removed and sent to a laboratory. Common side effects may include excessive gas, cramping, or bloating.



Tildy LaFarge, Media Relations Mt. Sinai


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Doctor Q and A

Read the entire Doctor Q&A for Richard Whelan, MD, Professor of Surgery, area of expertise in colorectal surgery and endoscopy

Read the entire Q&A