Early GI Cancer: Can It Be Removed Without Major Surgery?
Yes. Some early gastrointestinal (GI) cancers can be completely removed through an endoscope, potentially avoiding major surgery. This may be possible when the cancer is superficial and has a very low risk of spreading to the lymph nodes.
 
Advanced techniques such as endoscopic submucosal dissection (ESD) and, for selected difficult lesions, endoscopic full-thickness resection (EFTR) can remove abnormal tissue while preserving the affected organ. However, careful assessment is essential because not every early GI cancer is suitable for endoscopic treatment.
 
What is early GI cancer?
Early GI cancer is generally confined to the superficial layers of the digestive tract, although the exact definition and criteria for endoscopic treatment vary according to the organ and cancer type.
 
It can occur in the esophagus, stomach, colon or rectum and may cause no symptoms, which makes early detection particularly important.
Whether a lesion can be removed endoscopically depends on its size, location, appearance, suspected depth of invasion and risk of lymph-node spread.
 
Who may be eligible for endoscopic removal?
Endoscopic treatment may be considered when evaluation suggests that a cancer:

• Is limited to superficial layers
• Has a low predicted risk of lymph-node spread
• Can be completely removed endoscopically
• Does not show features suggesting deeper invasion
• Is suitable for treatment based on its size, location and appearance

The final decision depends on the type of cancer and individual patient factors.
 
How can early GI cancer be removed through an endoscope?

• ESD: Endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) is an advanced endoscopic technique used to remove larger, flat or complex superficial lesions. A flexible endoscope is passed through the mouth or rectum, and specialized instruments carefully dissect beneath the lesion.
A major advantage is en bloc removal, meaning the lesion is removed in one piece. This provides an intact specimen so a pathologist can assess the margins, depth of invasion, tumor characteristics and whether cancer cells are present in lymphatic or blood vessels.
For appropriately selected early cancers, complete ESD may be curative.
 

• EFTR: Endoscopic full-thickness resection with FTRD

Some lesions are more difficult to remove because of significant scarring, previous treatment or failure to lift away from deeper tissue.
For selected cases, particularly small difficult colorectal lesions, endoscopic full-thickness resection (EFTR) using a Full-Thickness Resection Device (FTRD) may be considered.
The device captures the lesion together with the full thickness of the bowel wall, closes the treatment area with a specialized clip and then removes the tissue.
EFTR is a more selective technique and may be useful for certain non-lifting, recurrent or scarred lesions that cannot be removed easily with conventional endoscopic methods.
 
How does a doctor know whether the cancer is superficial?
Assessment usually begins with high-definition endoscopy. Image-enhanced techniques can reveal surface and blood-vessel patterns, while the shape and appearance of the lesion can help estimate how deeply it has invaded.
Biopsy may provide additional information before treatment. Depending on the cancer and its location, endoscopic ultrasound (EUS), CT or MRI may also be used in selected cases.
Importantly, the final pathology after removal provides the most definitive assessment of invasion depth, resection margins and other features associated with risk of cancer spread.
 
Why choose endoscopic treatment instead of major surgery?
For carefully selected superficial cancers, endoscopic removal may avoid a more extensive operation.
Potential benefits include:

• No abdominal or chest incision
• Preservation of the affected organ
• Less postoperative pain
• Faster recovery
• An intact tissue specimen for detailed pathological assessment

 
However, endoscopic treatment does not always eliminate the need for surgery. If pathology identifies deeper invasion, lymphovascular invasion, an involved deep margin or other high-risk features, additional surgery or oncological treatment may be recommended.
 
Is ESD safe?
ESD is generally safe when performed by an experienced advanced endoscopist, but complications can occur. The main risks include bleeding and perforation.
Many complications can be recognized and treated endoscopically, although the individual risk depends on the lesion's size, location and complexity.
 
Can every early GI cancer be treated endoscopically?
No. Surgery remains an important treatment when a cancer has invaded more deeply or has a meaningful risk of lymph-node spread.
Treatment decisions depend on:

• Cancer type and location
• Size of the lesion
• Depth of invasion
• Pathological features
• Risk of lymph-node spread
• Possibility of complete endoscopic removal
• The patient's overall health

 
Advanced endoscopic treatment at Bumrungrad
At Bumrungrad International Hospital in Bangkok, the Digestive Disease (GI) Center and Gastrointestinal Endoscopy Unit provide advanced diagnostic and therapeutic endoscopy, including ESD and full-thickness endoscopic resection for appropriately selected lesions.
 
Bumrungrad was the first hospital in Thailand to perform EFTR using FTRD. Its Gastrointestinal Endoscopy Unit was also the first in Thailand and Southeast Asia to receive recognition through the American Society for Gastrointestinal Endoscopy's Endoscopy Unit Recognition Program.
 
In Newsweek and Statista's Best Specialized Hospitals Asia Pacific 2026, Bumrungrad ranked 10th in Gastroenterology and 58th in Oncology, placing No. 1 in Thailand in both specialties.
 
When GI cancer is detected while it is still superficial, endoscopic removal may provide selected patients with an organ-preserving alternative to major surgery. Careful staging, complete removal and detailed pathology are essential to determine whether endoscopic treatment alone is sufficient.
 
Medical references

1. Pimentel-Nunes P, Libânio D, Bastiaansen BAJ, et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022. Endoscopy. 2022;54(6):591–622.
2. Ferlitsch M, Hassan C, Bisschops R, et al. Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2024. Endoscopy. 2024;56(7):516–545.
3. Dinis-Ribeiro M, Libânio D, Uchima H, et al. Management of epithelial precancerous conditions and early neoplasia of the stomach (MAPS III): Guideline update 2025. Endoscopy. 2025;57(5):504–554.
4. Schmidt A, Beyna T, Schumacher B, et al. Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut. 2018;67(7):1280–1289.
5. Mueller J, Kuellmer A, Schiemer M, Thimme R, Schmidt A. Current status of endoscopic full-thickness resection with the full-thickness resection device. Digestive Endoscopy. 2023;35(2):232–242.
6. Manti M, Papaefthymiou A, Dritsas S, et al. Endoscopic Full Thickness Resection Device (FTRD) for the Management of Gastrointestinal Lesions: Current Evidence and Future Perspectives. Diagnostics. 2025;15(7):932.
7. American Society for Gastrointestinal Endoscopy. Endoscopy Unit Recognition Program. View source

 
Medically reviewed by:
Asst. Prof. Veeravich Jaruvongvanich, M.D.
Advanced Endoscopy; Gastroenterology & Hepatology
Last medically reviewed: September 2026