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Therapeutic endoscopy · London

Endoscopic submucosal dissection (ESD) - private in London.

An advanced endoscopic technique that removes early cancer and high-risk lesions in one piece - en-bloc - through the submucosal plane, with an electrosurgical knife. A curative alternative to oesophagectomy, gastrectomy or bowel resection in eligible patients.

A stethoscope on a clinical desk

Indicative pricing

What a private ESD costs in London.

Indicative all-inclusive ranges across our tertiary partner units, incl. day-case or overnight admission and pathology. Send the scope report and biopsies for a firm quote.

In short

A private ESD in London: £6,500–£12,000 all-inclusive, at a tertiary centre.

Procedure Indicative range
Diagnostic assessment, staging review and MDT discussion £900–£1,800
Colorectal ESD (LST >2 cm, day-case) £6,500–£10,500
Oesophageal ESD (Barrett’s or early SCC, overnight) £7,500–£12,000
Gastric ESD (early gastric cancer T1a, overnight) £7,500–£12,000
Ampullary ESD (selected cases, specialist centre) £8,000–£12,000
Second-opinion review of prior scope and histology £300–£500

Prices vary by centre, by which ESD endoscopist does the case, by lesion site and size, and by whether an anaesthetist-delivered GA is required.

The problem

En-bloc R0, not piecemeal. Curative endoscopy, not major surgery.

EMR is quick and safe for small lesions - but piecemeal EMR of anything over 2 cm risks incomplete margins and a 15 to 20% recurrence rate. ESD dissects through the submucosa and delivers the whole lesion as one specimen, so the pathologist can stage it and confirm cure. That is why en-bloc R0 matters.

  • En-bloc R0 vs piecemeal EMR

    ESD achieves en-bloc resection in >90% of cases and R0 in >85% at expert centres, with local recurrence under 3% versus 15 to 20% for piecemeal EMR.

  • A curative alternative to surgery

    For eligible early oesophageal, gastric and colorectal cancers, ESD avoids oesophagectomy, gastrectomy or bowel resection - if staging and histology support it.

When it helps

When ESD is the right step - and when it is not.

The lesions ESD was designed for - and the staging findings that mean surgery or oncology, not endoscopy, is the correct next step.

  • Early oesophageal squamous cell cancer

    T1a or high-grade squamous dysplasia in the oesophagus - en-bloc ESD gives curative resection and full histology without oesophagectomy.

  • Barrett’s-related early neoplasia

    Nodular high-grade dysplasia or T1a adenocarcinoma on a Barrett’s segment - ESD when the lesion is large, nodular or suspicious for submucosal invasion.

  • Early gastric cancer (T1a)

    Differentiated intramucosal gastric cancer meeting expanded criteria - ESD avoids partial or total gastrectomy in eligible patients.

  • Large colorectal LST over 20 mm

    Laterally spreading tumours with high-risk features (Kudo Vi, LST-NG pseudo-depressed, non-granular) where piecemeal EMR risks incomplete resection.

  • Residual or recurrent lesion at an EMR scar

    A tethered island of neoplasia at a prior EMR site - the non-lifting sign makes ESD the safer route to a clean margin.

  • Rectal neuroendocrine tumours

    Small (<15 mm) rectal NETs confined to the submucosa - ESD gives deeper, en-bloc resection than snare polypectomy or EMR.

  • Ampullary or duodenal lesions (selected)

    Non-invasive ampullary or large duodenal adenomas - performed only in specialist centres given the higher perforation and bleeding risk.

  • When ESD is not appropriate

    Deep submucosal invasion on EUS, lymphovascular involvement, poor performance status or lesions unsuitable for endoscopic cure - surgical or oncology referral instead.

Procedure options

ESD by site, plus the variants and their alternatives.

What each ESD option involves - and where an EMR, hybrid ESD or surgical referral fits better.

  • Oesophageal ESD

    General anaesthetic. Circumferential incision and submucosal dissection with a DualKnife or HookKnife. Overnight stay, PPI for 8 weeks, watch for stricture after wide resections.

  • Gastric ESD

    General anaesthetic. Standard for early gastric cancer meeting expanded criteria. Overnight admission with PPI and clear-fluid to soft diet 2 to 4 days.

  • Colorectal ESD

    Deep sedation or general anaesthetic. Day-case for most rectal and left-colon ESD; overnight if the defect is large or CO₂ retention is a concern.

  • Hybrid ESD

    A shortened dissection followed by snare resection of the remaining pedicle - faster than pure ESD, still en-bloc for lesions up to about 30 mm.

  • Pocket-creation method (PCM)

    A submucosal pocket is created before the mucosal incision - improves stability of the knife and traction in difficult colorectal lesions.

  • Traction-assisted ESD

    Clip-with-line or S-O clip traction lifts the flap during dissection - shorter procedure time, safer plane, particularly for large gastric or colonic lesions.

  • EMR (when ESD is not needed)

    For smaller lesions where en-bloc snare EMR is enough, we do not over-treat. See our EMR page for the full comparison.

  • Second-opinion review

    A specialist review of your scope report, images, biopsies and staging - sometimes the answer is EMR, watchful waiting or surgical referral, not ESD.

Safety and recovery

What to expect afterwards - honestly.

ESD is safe in expert hands but the risks are real - perforation, delayed bleeding and stricture - and the aftercare (diet, PPI, follow-up scope) needs to be planned before the day.

  • General anaesthetic or deep sedation

    Most upper GI ESDs are done under GA to protect the airway and allow a still field. Colorectal ESDs use deep propofol sedation or GA depending on lesion and centre.

  • Perforation - 2 to 5%

    Higher than EMR because the plane is deeper. Most perforations are recognised during the procedure and closed endoscopically with clips or over-the-scope clips; a minority need surgery.

  • Delayed bleeding - 5 to 10%

    Can occur up to two weeks after. A clear plan, PPI cover for upper GI ESD, and 24/7 contact with the unit matter more than the headline number.

  • Stricture after wide upper GI ESD

    Circumferential or near-circumferential oesophageal or antral ESD carries a real stricture risk - managed with dilatation, sometimes prophylactic steroid injection.

  • Overnight admission for upper GI ESD

    Standard for oesophageal and gastric ESD. Colorectal ESD is usually day-case unless the defect is large or the patient lives far from the centre.

  • Liquid to soft diet for 2 to 4 days

    Written aftercare covers a graded return to normal eating - clear fluids, then free fluids, then soft, then normal - to protect the fresh scar.

  • PPI for 8 weeks after upper GI ESD

    A twice-daily proton-pump inhibitor helps the resection ulcer heal and reduces delayed bleeding. Do not stop early.

  • Follow-up scope at 3 to 6 months

    Even after R0 en-bloc resection, a check gastroscopy or colonoscopy at 3 to 6 months confirms healing and looks for metachronous lesions.

  • Red flags after discharge

    Severe pain, fever, vomiting blood, dark or bright rectal bleeding, or black stools - call the unit or go to A&E the same day.

Reading your endoscopy report

Your ESD report in four parts. Read the last one first.

Whichever site was treated, the report the endoscopist sends you keeps to the same shape.

A UK gastroenterologist reviewing an ESD endoscopy report

A quiet reminder

Endoscopy language is precise and can read coldly - ask your care team to explain anything that is unclear.

Ask your care team to explain anything that is unclear.

  1. 01 Header

    Site, size and Paris/JNET classification

    Where the lesion was, its size in millimetres, and its Paris morphology (Is, IIa, IIc) with NICE/JNET or Kudo pit pattern.

  2. 02 Technique

    Injection, incision and dissection

    Which submucosal solution was used, whether a DualKnife, HookKnife or ITknife was used, en-bloc versus piecemeal, and any traction technique.

  3. 03 Findings

    Complications and completeness

    Any intra-procedure bleeding, muscle exposure, micro-perforation and how it was closed, and the endoscopist’s judgement on en-bloc and R0 resection.

  4. 04 Impression

    Histology plan, MDT and surveillance

    Read this first: when histology is expected, the MDT date, PPI or diet advice, and when your surveillance scope is booked.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for ESD varies by insurer and by indication - usually funded when medically indicated for early cancer or high-grade dysplasia.

Frequently asked

Everything we get asked about ESD.

Quick answers on en-bloc resection, perforation, recovery, surgery and insurance.

  • Why does en-bloc resection matter?

    Removing the lesion in one piece means the pathologist can measure the deep and lateral margins accurately, grade the tumour, and check for lymphovascular invasion. That is what tells you whether the resection is curative (R0) or whether you need surgery. Piecemeal EMR of a larger lesion cannot give the same staging and carries a 15 to 20% local recurrence rate versus under 3% after en-bloc ESD.

  • What is the risk of perforation with ESD?

    Perforation occurs in 2 to 5% of ESD cases - higher than EMR because the dissection plane is deeper. In expert centres almost all perforations are recognised at the time and closed endoscopically with clips or over-the-scope clips, with no need for surgery. This is one of the reasons ESD should be done in a tertiary unit with surgical backup.

  • What is the recovery time?

    Colorectal ESD is usually a day-case with a soft diet for 2 to 4 days and a return to normal activity within a week. Oesophageal and gastric ESD involve one night in hospital, a graded diet from clear fluids to soft food over 2 to 4 days, a twice-daily PPI for 8 weeks, and no heavy lifting for two weeks.

  • Is ESD an alternative to surgery?

    For eligible early lesions - T1a oesophageal or gastric cancer, high-grade dysplasia in Barrett’s, large non-invasive colorectal LSTs - ESD is an alternative to oesophagectomy, gastrectomy or bowel resection. It requires strict staging (EUS, imaging, biopsies) and MDT sign-off. If histology after ESD upgrades the risk (deep submucosal invasion, lymphovascular invasion, poor differentiation), surgery is still recommended.

  • Will my insurance cover ESD?

    Most major UK insurers - Bupa, AXA Health, Vitality, Aviva, WPA, Cigna, Healix - cover ESD when it is medically indicated for early cancer or high-grade dysplasia, with a specialist referral and pre-authorisation. Self-pay quotes are also available.

  • How often will I need follow-up scopes?

    Standard practice is a check gastroscopy or colonoscopy at 3 to 6 months to confirm scar healing and look for any residual or metachronous lesions, then annually for at least 3 years for upper GI ESD and 1 year for colorectal ESD. Barrett’s patients continue on their normal Barrett’s surveillance schedule.

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