Minimally invasive endoscopic treatment for early digestive-tract lesions
EMR/ESD Treatment
EMR and ESD remove selected early digestive-tract lesions through an endoscope, without open surgery. Some major centers in China have extensive experience; suitability and recovery depend on hospital assessment.
Discuss language, time, destination, and itinerary preferences. Do not submit medical records, images, or attachments here.
Treatment Advantages In China
Estimated Treatment Costs
The estimated cost of an ESD care pathway, including preoperative examinations, the procedure, anesthesia, and hospitalization, is approximately USD 2,100–4,300, converted at CNY 7 = USD 1. Costs vary by hospital and are subject to individual assessment; the hospital’s itemized written estimate prevails.
Extensive Procedural Experience
China has a high volume of gastrointestinal tumors, and major endoscopy centers perform large numbers of ESD procedures. Patients can access teams with substantial procedural experience and mature endoscopic techniques.
Organ-Preserving Treatment Without Open Surgery
Mature EMR and ESD programs can remove selected lesions endoscopically without open abdominal surgery, helping preserve the structure and function of the stomach, esophagus, or intestine. Patients commonly resume eating within 24-48 hours and leave hospital within 3-7 days, subject to clinical assessment.
Treatment Scheduling
Scheduling depends on the hospital’s assessment, procedure availability, and the patient’s condition. The hospital will confirm the expected timeline after reviewing the case.
Quick Overview Of EMR / ESD
Review the treatment methods, assessment scope, pre-arrival preparation, hospital pathway, and post-procedure priorities. Suitability for endoscopic treatment must be assessed by the receiving hospital.
What Are EMR And ESD?
View detailsBoth techniques remove superficial lesions through a gastrointestinal endoscope. The choice depends on lesion characteristics and pathology requirements. When clinically appropriate, the goals are complete removal, organ preservation, and follow-up based on postoperative pathology.
Assessment Scope And Situations That May Not Be Suitable For Direct Endoscopic Treatment
View detailsSuitability depends on lesion location, endoscopic appearance, pathology, invasion risk, and overall health. Suspected deep invasion or an inability to achieve safe, complete removal may rule out direct endoscopic treatment.
Documents For An International Patient's Initial Review
View detailsPrepare recent endoscopy reports with high-resolution images or complete video, pathology reports, previous treatment records, available imaging, and a complete medication list.
Standard Hospital Pathway
View detailsThe pathway commonly includes expert endoscopy review, pathology or imaging assessment when needed, multidisciplinary decision-making, preoperative and anesthesia assessment, treatment, observation, and a pathology-led follow-up plan.
Post-Procedure Recovery Priorities
View detailsFollow the hospital's instructions for diet, medication, and activity. Bleeding, perforation, infection, stricture, and non-curative resection risks must be assessed and managed by the receiving team.
Care Journey
- 01
Remote consultation and matching
Our care coordination team will help you confirm the receiving hospital's requirements for preparing materials and the appropriate submission channel.
- 02
Itinerary planning and preparation
Our coordinators will assist in signing service agreements, applying for medical visas, booking air tickets, and coordinating accommodation near the hospital.
- 03
Arrival and landing services
Arrange pick-up at the airport or station, and bilingual staff will accompany you for check-in.
- 04
Full accompaniment of in-hospital diagnosis and treatment
From examination, outpatient consultation to admission, you are accompanied by professional medical interpreters to ensure clear to doctor-patient communication.
- 05
Surgery and rehabilitation implementation
The surgical team performs surgery and develops an individualized rehabilitation plan.
- 06
Discharge and continuing care
You will receive a detailed home rehabilitation plan and regular follow-up via online video.
Medical team
Review hospitals and specialists with relevant experience in this treatment. Availability, team composition, and admission arrangements must be confirmed with the receiving hospital.
Hospitals
Renji Hospital, Shanghai Jiao Tong University School of Medicine
Shanghai
Its therapeutic-endoscopy program includes EMR, ESD, and POEM.
Peking Union Medical College Hospital
Beijing
Its gastroenterology department provides advanced endoscopy, including EMR and ESD for selected early lesions.
Changhai Hospital
Shanghai
It has established clinical, research, and training experience in early gastrointestinal cancer and complex therapeutic endoscopy.
West China Hospital, Sichuan University
Chengdu, Sichuan
Its gastroenterology team covers early-cancer detection, staging, ESD, pathology review, and follow-up.
Beijing Friendship Hospital, Capital Medical University
Beijing
The team provides advanced-endoscopy training and complex procedures.
The First Affiliated Hospital, Sun Yat-sen University
Guangzhou, Guangdong
It combines endoscopy, pathology, surgery, and multidisciplinary care for complex early gastrointestinal lesions.
Zhongshan Hospital, Fudan University
Shanghai
Its established minimally invasive platform includes ESD, ESE, STER, and EFR.
Nanfang Hospital, Southern Medical University
Guangzhou, Guangdong
Its advanced-endoscopy team provides ESD, POEM, STER, and EFTR for selected gastrointestinal lesions.
Frequently asked questions
Q1: Which is better, EMR or ESD?
There is no absolute "better". EMR is preferred for small, well-circumscribed lesions with a low risk of deep invasion; ESD is more likely to be considered when en bloc pathology evaluation is required, the lesion is large, or fibrosis is present.
Q2: Can ESD replace surgery?
This is only true for superficial lesions that meet the criteria for endoscopic resection. If deep invasion or a higher risk of lymph node metastasis is suggested, surgery is usually still the more appropriate oncologic treatment.
Q3: Will it be cured after cutting it off?
You cannot judge based on "clean cuts with the naked eye" alone. Pathological evaluation of resection margins, depth of invasion, differentiation, lymphovascular invasion, etc. must be awaited.
Q4: Why do we need to review the pathology?
The pathological results directly determine whether it is a curative resection. It is recommended that overseas patients or complex lesions be reviewed by an experienced gastrointestinal pathologist.
Q5: Do I need to have a gastroscopy or colonoscopy again?
Not necessarily. If the original image is incomplete, of insufficient quality, and the lesion boundary or risk of infiltration cannot be judged, the receiving center may recommend re-doing high-definition, magnification, or chromoendoscopy.
Q6: What should I do if I take aspirin, clopidogrel or anticoagulants?
Do not stop taking this medication on your own. The plan should be developed jointly by the endoscopist, prescriber, and anesthesia team based on the risk of bleeding and thrombosis.
Q7: What are the main complications?
These include intraoperative or delayed bleeding, perforation, infection, pain, and stricture after extensive esophageal resection. Complicated cases may require repeat endoscopic or surgical management.
Q8: How long will it take to resume normal eating and traveling after surgery?
It depends on the treatment site, extent of resection, intraoperative conditions, and recovery. It should be based on the discharge doctor's orders and cannot be guaranteed with a uniform number of days.
Detailed information
What Are EMR And ESD?
EMR (endoscopic mucosal resection) and ESD (endoscopic submucosal dissection) remove superficial gastrointestinal lesions through an endoscope. When clinically appropriate, the goals are complete lesion removal, organ preservation, and follow-up planning based on postoperative pathology.
EMR | Endoscopic Mucosal Resection
After the lesion is lifted, it is removed with a snare; some larger lesions may be removed in pieces.
ESD | Endoscopic Submucosal Dissection
The mucosa is cut around the lesion and gradually dissected along the submucosal layer, aiming for en bloc removal.
Assessment Scope And Situations That May Not Be Suitable For Direct Endoscopic Treatment
Who May Be Assessed For EMR / ESD
Suitability must be assessed by the receiving hospital based on lesion location, endoscopic appearance, pathology, and invasion risk.
- Esophagus: high-grade intraepithelial neoplasia, selected early squamous cancers, Barrett's esophagus-related high-grade dysplasia or superficial tumors, and selected local residual or recurrent lesions after prior endoscopic treatment.
- Stomach: adenoma, high-grade intraepithelial neoplasia, selected early gastric cancers, and larger superficial lesions requiring precise margin definition or en bloc pathology.
- Colon and rectum: laterally spreading tumors, larger sessile or flat lesions, lesions with suspected superficial submucosal invasion requiring en bloc removal, and selected residual or recurrent lesions.
- Duodenum and special locations: individual assessment at a high-volume center is recommended because duodenal ESD is not routine and carries higher technical and adverse-event risks.
When EMR / ESD May Not Be The Direct Next Step
- Endoscopic appearance or imaging suggests deep submucosal invasion, muscular involvement, or a high risk of regional lymph-node metastasis.
- The lesion's location or extent prevents safe, complete endoscopic removal and surgery better meets oncologic principles.
- Severe coagulation abnormalities, unstable cardiopulmonary function, or uncontrolled anesthesia risk.
- Anticoagulant or antiplatelet therapy without a perioperative plan agreed by the prescribing clinician, endoscopist, and anesthesia team.
- The lesion has not yet undergone high-quality endoscopic assessment and required pathology review.
Documents For An International Patient's Initial Review
Recommended Documents
The receiving institution will advise whether any examinations need to be added or repeated.
- The latest gastroscopy or colonoscopy report, with original high-resolution images or complete video.
- Pathology report and, when available, slides, paraffin blocks, or digital pathology files.
- Records of previous EMR/ESD, polyp removal, surgery, radiotherapy, or systemic therapy.
- EUS, contrast-enhanced CT, MRI, or PET-CT if already completed; not every patient needs repeat imaging.
- A complete medication list, especially anticoagulants, antiplatelet agents, diabetes medication, and allergy history.
- Cardiopulmonary conditions, implanted cardiac devices, anesthesia history, and previous bleeding or thrombotic events.
Standard Hospital Pathway
Expert Endoscopy Review
An advanced-endoscopy specialist reviews the records and determines whether high-definition white-light, chromoendoscopy, virtual chromoendoscopy, or magnifying endoscopy should be repeated.
Pathology And Imaging Assessment
Pathology is reviewed when needed. EUS or other imaging may be selected for lesions with suspected deeper invasion or submucosal involvement.
Multidisciplinary Decision
When needed, endoscopy, pathology, surgery, oncology, and anesthesia teams jointly determine whether EMR, ESD, another advanced endoscopic technique, or surgery is appropriate.
Preoperative Tests And Anesthesia Assessment
Complete blood tests, electrocardiography, and anesthesia assessment; establish a plan for antithrombotic medication management.
Treatment
Perform EMR or ESD, with hemostasis, wound management, or endoscopic closure as required during the procedure.
Post-Procedure Observation
Monitor for bleeding, perforation, infection, pain, fever, and tolerance of oral intake.
Pathology Results And Follow-Up Plan
After the pathology report is available, determine whether the resection was curative and plan surveillance endoscopy or additional treatment.
Post-Procedure Recovery Priorities
Diet, Medication, And Activity
Follow hospital instructions for diet progression, acid suppression or mucosal protection, and activity according to the procedure site.
When To Contact The Hospital Immediately
Seek immediate medical advice for vomiting blood, black stools, fresh blood in stool, persistent chest or abdominal pain, fever, breathing difficulty, or marked weakness.
Preventing Esophageal Stricture
Extensive esophageal resection requires particular attention to stricture risk; some patients may need preventive treatment or later dilation.
Postoperative Pathology And Follow-Up
High-risk pathology findings should be reviewed by a multidisciplinary team rather than treated as complete simply because the visible lesion was removed. Even after curative resection, regular endoscopic surveillance is required according to lesion site and pathology risk.
