Minimally Invasive Solutions for Organ Preservation and Prevention of Complex Surgical Operations
In the past, the discovery of a large polyp, a superficial tumor, or a submucosal finding required invasive surgery involving the removal of a portion of the intestine or stomach. Today, thanks to advanced technologies, these complex resections can be performed via endoscopy (through the mouth or rectum), without abdominal incisions and while fully preserving the organ.
Dr. Vosko specializes in four primary approaches, which he tailors precisely to the depth, type, and location of the tumor:
- EMR - Endoscopic Mucosal Resection
- ESD - Endoscopic Submucosal Dissection (The advanced method)
- STER - Submucosal Tunneling Endoscopic Resection
- EFTR - Endoscopic Full-Thickness Resection
Dr. Vosko is one of Israel's leading experts in performing advanced endoscopic resections. His high level of skill allows for the removal of precancerous and early-stage cancerous lesions in the esophagus, stomach, and colon-sparing the patient from major surgery, stomas, and prolonged recovery periods.
Have you been told you need surgery to remove a polyp?
Schedule a consultation to explore the possibility of an endoscopic removal.
Who is the Treatment Suitable For?
This treatment is intended for patients with findings that cannot be removed via standard colonoscopy:
- Giant Polyps: Large, flat polyps (LST - Lateral Spreading Tumors) in the colon exceeding 2-3 cm in size.
- Early Cancer: Tumors in the esophagus or stomach that have not penetrated the deep muscle layer.
- Rectal Lesions: Low-lying lesions where surgical removal would typically require a stoma (ostomy bag). The ESD procedure prevents this.
- Recurrent Lesions: Polyps that have recurred following an incomplete resection in the past.
Overview of the 4 Advanced Endoscopic Resection Methods
The 4 methods can be divided into 2 groups:
- Treatment of superficial lesions and polyps (most common).
- Treatment of deep tumors.
Let's start by reviewing the first group:
Resection of Polyps and Superficial Tumors (Mucosal Resection)
These methods are intended for lesions growing from the mucosa (the inner lining) towards the lumen of the organ.
EMR - Endoscopic Mucosal Resection
Suitable for medium-sized polyps (over 20mm) that are not suspected of deep malignancy. The physician injects fluid under the polyp to lift it and resects it using an electric loop (Snare). The method is effective and safe for most colon polyps.
ESD - Endoscopic Submucosal Dissection (The Advanced Method)
This is the pinnacle of endoscopic technology. It is a method that allows "peeling" large, flat tumors in their entirety (En-bloc) from the organ wall, through the endoscope, while keeping the organ intact.The method was developed in Japan and allows for the resection of very large masses or early-stage cancerous tumors. Unlike EMR, here Dr. Vosko uses a tiny electric knife to "peel" the tumor with great precision.
The Advantage: More accurate pathological diagnosis and a lower chance of tumor recurrence.
Now let's review the second group:
Resection of Deep and Submucosal Tumors
When the tumor is deep within the stomach or esophageal wall (such as GIST or neuroendocrine tumors), standard methods are insufficient. Dr. Vosko uses breakthrough techniques to treat these cases:
STER - Submucosal Tunneling Endoscopic Resection
In this method, the endoscope is introduced through a "tunnel" created between the wall layers up to the tumor. This allows for the removal of deep tumors in the esophagus and stomach while keeping the outer mucosa intact, preventing leaks and strictures.
EFTR - Endoscopic Full Thickness Resection
The most "surgical" method. Intended for tumors involving the full thickness of the wall. The device grasps the tumor together with the wall, resects it, and simultaneously closes the hole created using a special clip. This is a direct substitute for laparoscopic surgery.
The difference between "piecemeal resection" and "complete en-bloc removal".
- Organ Preservation: This is Dr. Vosko's therapeutic philosophy. The goal is to cure the cancer without compromising the patient's quality of life.
- Technical Skill - Full Toolbox: Dr. Vosko is one of the few who masters the entire spectrum of treatments - from EMR for polyps, through creating "tunnels" (STER) for deep tumors, to mastery in ESD. Performing ESD requires the highest level of precision in endoscopy ("delicate surgery through a tube").
The fact that Dr. Vosko is skilled in these cutting-edge techniques (STER/EFTR) guarantees that even in ESD and EMR procedures, you are in the most experienced and safe hands.
Remove the tumor, save the body.
Dr. Vosko invites you to check your eligibility for advanced endoscopic resection.
How is the treatment carried out?
How is the consultation conducted?
The treatment is tailored to the size and type of the lesion and is performed using a "step-by-step" approach:
- The ESD Method (For large lesions):
- Marking: Defining the boundaries of the lesion using delicate cauterization.
- Injection: Injecting fluid beneath the lesion to lift it and separate it from the muscle layer (creating a "safety cushion").
- Incision: A circumferential incision of the mucosa around the lesion.
- Dissection: Using a specialized endoscopic knife to detach the lesion from below, millimeter by millimeter, until it is fully removed in one single piece (En-bloc).
- Closure: If necessary, closing the site with clips or suturing (Overstitch).
- Marking: Defining the boundaries of the lesion using delicate cauterization.
- The EMR Method (The "Little Sister"):For smaller lesions, the lesion is lifted via injection and captured with a Snare that resects it all at once. This is a fast and efficient method for standard polyps.
- The STER Method (For deep tumors in the esophagus/stomach):The physician creates a small opening in the mucosa at a distance from the tumor, inserts the endoscope into the space between the mucosa and the muscle, and creates a "tunnel" to reach the tumor. The tumor is resected and removed through the tunnel, and the entry point is closed with clips. The Advantage: The mucosa covering the tumor remains intact.
- The EFTR Method (For Full-Thickness Resection):This method involves a specialized device (FTRD) mounted on the endoscope. The device captures the tumor along with the full thickness of the organ wall, applies a durable metal clip to ensure a leak-proof seal at the base, and only then resects the tumor. This allows for complete removal without leaving an open hole in the bowel or stomach.
How should I prepare for treatment?
How should I prepare for the consultation?
The preparation depends on the lesion's location and is identical to the preparation for a diagnostic exam:
- In the Stomach/Esophagus: Complete fasting (no food or drink) for 8 hours before the procedure.
- In the Colon: Complete emptying of the bowel is required by drinking a laxative (full colonoscopy preparation) and a low-fiber diet 3 days prior. Bowel cleanliness is critical for the safety of the procedure.
- Medications: It is mandatory to stop blood thinners in prior consultation with a doctor, due to the surgical nature of the procedure.
What to expect the day after? (Recovery and recuperation)
- Hospitalization: In ESD treatments, hospitalization for one night is usually required for observation to ensure there are no unusual pains or immediate complications. In EMR, discharge is usually on the same day.
- Diet: Gradual return to eating (initially liquids and soft diet) in the first days to protect the resection area.
- Results (Pathology): The resected lesion is sent to the laboratory to examine the margins under a microscope. If the margins are clean and the resection is complete - the patient is considered cured ("Curative Resection") and further surgery is avoided.
Are there risks or side effects?
These are advanced invasive procedures, and the risks are slightly higher than a standard exam, but in skilled hands, they are rare and treated on the spot:
- Bleeding: Can occur during the procedure (and treated immediately with cauterization) or in the days following (delayed bleeding).
- Perforation: A small hole in the organ wall. Thanks to Dr. Vosko's skill, in the absolute majority of cases, the perforation can be closed immediately during the procedure using clips, without the need for surgery.
Information for patients from abroad (medical tourism)
The unit is equipped to receive patients from abroad and collaborates with agents for a full logistical package.
Direct inquiries are also welcome for quick and efficient coordination.
Complex patients who are candidates for radical surgeries come to Dr. Vosko in an attempt to save the organ using ESD.
For your convenience, Dr. Vosko speaks 3 languages: Hebrew, English, and Russian.
Is it permitted for me to continue taking aspirin or blood thinners?
After a large resection (EMR), blood thinners are usually stopped for several days to prevent delayed bleeding. Resuming these medications should only be done under the guidance of Dr. Vosko, according to the size of the resection and your individual risk.
When is my next colonoscopy?
This depends on the biopsy findings. If the polyp was large or advanced pre-cancerous, a first follow-up is usually required within 3-6 months to ensure there are no remnants. Dr. Vosko will provide a precise written recommendation.
Is late bleeding possible?
Yes. Sometimes the scab falls off after 5-7 days and causes sudden bleeding. This is rare, but it is important to remain vigilant during the first week and stay close to medical assistance (do not travel abroad immediately).
Is it safe to use the bathroom after polyp removal?
Yes, but avoid strong straining (pushing) during the first few days. If you notice a small amount of blood on the paper, this is normal. If there is a large amount of blood in the toilet bowl, go to the emergency room.
Does removing the polyp guarantee that I do not have cancer?
The removal eliminates the lesion from the body, which is excellent. However, the final answer can only be provided by the pathologist, who examines the tissue under a microscope. They determine whether the margins are clear and if any cancerous cells were present. Dr. Vosko will contact you as soon as the results are available.
We are with you - from the very first call, we understand that on the other end of the line is a person who may be concerned or in pain, waiting for answers. Therefore, we have built a service system that truly sees you:
- High Availability: A live service center is active Sunday-Thursday from 09:00 AM to 07:00 PM and on Fridays from 09:00 AM to 02:00 PM. In urgent cases, we are available beyond these hours.
- Direct WhatsApp Line: Do you have a question about fasting? Did you forget to ask something about your medications? Our customer service is available via WhatsApp for a quick response.
- Peace of Mind from Bureaucracy: Our team is highly experienced in working with insurance companies and supplemental health plans. We will assist you in preparing the necessary paperwork and authorizations so that you can focus entirely on your health.
Advanced Endoscopic Resections of Cancerous and Pre-Cancerous Lesions (Polyps) - ESD/EMR/STER/EFTR
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