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Last updated: 14-Oct-2026
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Robotic Cancer Surgeon (GI)
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad · 18 years of experience
★★★★★ Google: 4.9 from 53 reviews (Gota clinic) · 5.0 from 25 reviews (Apollo, Bhat)
In short
ESD removes a very early stomach cancer through the endoscope. There is no cut on the belly, the whole stomach stays, and no robot is used.
It suits only cancers that sit in the inner lining and have a low chance of reaching the lymph nodes. Deeper or riskier cancers need a gastrectomy instead.
The tissue report after ESD settles the plan. If every safety rule is met, regular endoscopy follows. If any rule is broken, an operation with lymph nodes follows.
ESD is an endoscopy procedure, not a robotic operation. The robot comes in only when the cancer is not suitable for ESD, or when ESD shows it needs more.
ESD stands for endoscopic submucosal dissection. A thin flexible tube goes through the mouth into the stomach. The cancer is lifted and peeled off the stomach wall in one piece. It is done under deep sedation by an endoscopist trained in this method.
A robotic gastrectomy is a full operation under general anaesthesia. Part or all of the stomach is removed, together with the lymph nodes around it. ESD cannot remove lymph nodes. That single fact decides who can have ESD and who cannot.
Every early stomach cancer is reviewed jointly before treatment. The endoscopist, the surgeon and the pathologist decide together. Dr Harsh Shah is the surgeon in that review, and performs the gastrectomy when one is needed.
Four things decide it: how deep the cancer goes, how its cells look, its size, and whether it has an ulcer. The biopsy and endoscopy answer most of these.
| What the reports show | Usual advice |
|---|---|
| Cancer only in the inner lining, well-formed cells, no ulcer, any size. | ESD. |
| Inner lining only, well-formed cells, with an ulcer, up to 3 cm. | ESD can be offered. |
| Just into the next layer by a sliver, well-formed cells, up to 3 cm, no spread into small vessels. | ESD can be offered. |
| Inner lining only, poorly formed cells, no ulcer, up to 2 cm. | ESD can be offered. |
| Poorly formed cells with an ulcer. | Operation. |
| Deeper growth into the next layer. | Operation. |
| Cancer cells seen in small vessels on the biopsy. | Operation. |
| Growth into the muscle wall or beyond. | Operation. |
Some people are not suited to ESD for other reasons. These include cancer or severe precancer spread across much of the stomach, a cancer that came back at an old ESD site, and the inherited CDH1 gene change. Blood thinners that cannot be stopped safely, and severe heart or lung disease, also count against it.
A careful endoscopy, a biopsy from the edge of the lesion and a CT scan come first. An endoscopic ultrasound is added when the depth is uncertain.
The edges are marked, the lining is lifted with fluid, a ring is cut around it, and the layer beneath is peeled away until the lesion comes out whole.
You usually stay overnight. Acid-lowering medicine is given through a drip and then by mouth for some weeks. Clear fluids start once there is no sign of bleeding, then soft food. Most people go home on the second day.
ESD is counted as complete only when the report meets every rule. If even one rule is broken, an operation to remove lymph nodes is advised.
| Report finding | Next step |
|---|---|
| Removed in one piece, clear edges, well-formed cells, within the size limits, at most a sliver into the next layer, no vessel or nerve spread. | Complete. Regular endoscopy follows, and no operation is needed. |
| Cancer at the cut edge. | Completion gastrectomy with lymph nodes. |
| Deeper growth than expected. | Completion gastrectomy with lymph nodes. |
| Cancer seen in small vessels. | Completion gastrectomy with lymph nodes. |
| Larger than the limits for its cell type. | Completion gastrectomy with lymph nodes. |
| Only a sliver deep, but with poorly formed cells. | Watching or surgery is discussed with you. |
A completion gastrectomy is planned four to eight weeks after ESD, once the lining heals. Waiting this long does not harm the result.
The operation removes the lower part or the whole stomach, depending on where the cancer was. The lymph nodes around the stomach come out with it, in a D2 clearance. The robot gives a steady 3D view and wristed instruments for that node work. It does not change what is removed.
How the approach is chosen is set out in robotic, keyhole or open gastrectomy. The operations themselves are on the robotic distal gastrectomy and robotic total gastrectomy pages.
| Question | ESD | Gastrectomy |
|---|---|---|
| How is it done? | Through the mouth with an endoscope. | Through small cuts, robotic or keyhole, or open. |
| Anaesthesia? | Deep sedation. | General anaesthesia. |
| Stomach after? | The whole stomach stays. | Part or all of it is removed. |
| Lymph nodes? | Not removed. | Removed and checked. |
| Hospital stay? | Short. | Longer. |
Bleeding can happen during ESD or in the two weeks after. Most is stopped through the endoscope with heat or clips. A small hole in the stomach wall can occur. It is usually closed with clips through the scope, and an operation is rarely needed. Months later, a scar near the top or the outlet of the stomach can narrow it. This is stretched with a balloon through the endoscope.
Endoscopy is repeated at three, six and twelve months, then every year for life. H. pylori is treated and its clearance is checked.
The lifelong checks matter for two reasons. The old site can show cancer again. A new early cancer can also start in another part of the stomach. Found early, either can often be treated again by ESD or by surgery. Treating H. pylori lowers the chance of a new cancer, so it is part of your discharge plan.
No. ESD is done through an endoscope passed through the mouth, under deep sedation. The robot is used only when a gastrectomy is needed.
No. It suits cancers in the inner lining with a low chance of lymph node spread. Deeper cancers, some ulcerated ones and those in small vessels need an operation.
If any safety rule is broken, a completion gastrectomy with lymph nodes is advised. It is usually done four to eight weeks after ESD.
Yes. ESD removes only the lining around the cancer. The whole stomach stays, so eating usually returns to normal.
At three, six and twelve months, then every year for life. H. pylori is treated, and its clearance is checked.
Stomach cancer surgery at this centre is covered on the robotic stomach cancer surgery page. For questions before you travel, call +91-63590-11009.
Shah’s Gastro, Cancer & Robotic Surgery Centre, Gota, Ahmedabad
Consultation, review of endoscopy and biopsy reports, second opinions and follow-up.
Apollo Hospital, Bhat, Gandhinagar
Admission, robotic and open surgery, and inpatient care.
Told the stomach cancer was found early? The endoscopy report with photos, the biopsy report and any CT report can be sent ahead on WhatsApp, so the visit starts with them already read. Whether ESD or an operation suits you is decided at the consultation, after examination. Call +91-63590-11009 Send reports before your visit
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