Eighty-three year old Mr Tan Ah Liang had been bugged by gastric pains since he was a young man. It happened so often that he did not think anything was amiss when the old problem surfaced about a year ago.

However, this time round, the pain got worse, and so he sought treatment at a nearby polyclinic which then referred him to CGH.

It was here that Mr Tan was diagnosed with early stomach cancer. He was found to have two tumours growing in his stomach - one was an early cancer, while the other was precancerous.

Given his old age, he was recommended to undergo Endoscopic Submucosal Dissection (ESD) to have his tumours removed instead of the conventional gastrectomy, which is the removal of part or all of the stomach.

According to Consultant Gastroenterologist Dr Ang Tiing Leong who saw Mr Tan, ESD is a much less invasive procedure. Unlike gastrectomy, ESD allows the preservation of the entire stomach, and so patient’s recovery time is shorter. This is achieved through an advanced endoscopic technique where with the use of special endoscopy knives, the submucosal layer of the stomach wall is dissected.

This allows en bloc resection of the entire early stomach cancer, which means that the tumour is cut out in its entirety, in one piece.

“En bloc resection will allow accurate histopathological assessment of the margins of resection, and reduce the risk of local recurrence,” explains Dr Ang.

“Local recurrence may occur if the resection is piecemeal, which is when the tumour is cut out in multiple small pieces. This was the situation in earlier attempts at endoscopic resection for early stomach cancer, which rendered the alternative non-viable.”

With ESD, this problem was resolved.

Mr Tan took up Dr Ang’s recommendation and had both his tumours removed successfully through ESD. The best part is he still has his stomach intact.

“It was good that Mr Tan took this procedure as there were fewer risks for him due to his age,” says Dr Ang.

“Most importantly, the long term results of ESD for early gastric cancer are the same as conventional surgery when patients satisfy the treatment criteria,” he adds.

To date, CGH have performed ESD on 13 patients, all of whom have recovered completely.

As with all surgery, ESD is not without its risks, with the main one being perforation, which runs at between 4 to 5 per cent. But in over 90 per cent of the instances, the perforation can be treated endoscopically by endoscopic clipping.

In about 3 per cent of the cases, there may be delayed bleeding, which is treatable by endoscopy.

Says Dr Ang: “ESD is a technically challenging and difficult procedure. To perform ESD, special training is required, and the doctor needs to be a skilful endoscopist.”

Mr Tan’s third son, Mr William Tan, says: “We’re very happy with the outcome. Dr Ang had explained to us that ESD would cause much less pain than the conventional treatment. Indeed, my father said he felt no pain throughout the entire process. In fact, on the same day he was discharged home, he was back to his daily routine activities and usual diet of steamed fish, oats and white bread.”

And in the Senior Tan’s simple Teochew words, undergoing the operation was just “plain easy”.

For more information on CGH Division of Gastroenterology, please visit
http://www.cgh.com.sg/medical/gastroenterology.asp