Endoscopic therapeutic esophageal interventions: something old, something new, something to be established

Abstract

Endoscopic esophageal interventions are an exciting topic because indications for the use of both the available devices and the new devices continue to evolve. This article reviews the most notable developments and the results of endoscopic esophageal therapeutic interventions published in 2003. In 2003, three follow-up series on photodynamic therapy were published. Photodynamic therapy was shown to improve dysphagia from esophageal cancer, but comparative studies with other techniques are needed. Photodynamic therapy was also effective in removing Barrett epithelium. Of concern is that patients with residual Barrett esophagus after ablative treatment are still at an increased risk for esophageal cancer. Endoscopic mucosal resection has become an accepted alternative for surgical resection of early-stage esophageal cancer, with increasing evidence that lesions larger than 20 mm can be safely removed by this technique. Completely covered plastic self-expanding stents have been demonstrated to reduce recurrent dysphagia by the ingrowth or overgrowth of nonmalignant tissue. A new indication for self-expanding metal stents is the treatment of traumatic nonmalignant perforations of the esophagus. Stents are also increasingly used for strictures refractory to repeated dilations and as an alternative to pneumatic dilation in achalasia. Bleeding esophageal varices can safely be treated with vasoactive drugs, which is good news for endoscopists who value a good night's rest. Various follow-up studies of endoscopic antireflux procedures were published that suggested good symptomatic results. However, with respect to the reduction of acid exposure to the esophagus, these data were less impressive. In 2003, much additional data about current techniques became available. In addition, new indications for existing devices were developed. Finally, for some techniques more information will be needed before their exact role can be established.