The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Endoscopic submucosal dissection (ESD) of gastric lesions.


This procedure can be used to treat abnormalities on the wall of the stomach. A long camera (endoscope) is inserted through the oesophagus and into the stomach to view the affected area. A solution is injected into the wall of the stomach, and then the part of the stomach wall that looks abnormal is removed with special instruments. The aim of the procedure is to help avoid the need for open surgery, and to obtain a good quality sample for examination under the microscope.

Coding recommendations

G42.1 Fibreoptic endoscopic submuscosal resection of lesion of upper gastrointestinal tract

Z27.2 Stomach

OPCS-4 code Y07.2 Clipping of organ NOC may also be assigned if clips are used.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)