Endoscopic therapeutic esophageal interventions.
Despite numerous advances in the chemotherapeutic, radiotherapeutic, and surgical treatment of esophageal cancer, most patients require some type of endoscopic palliation for dysphagia during the course of their illness. Numerous modalities exist, including thermal ablation with neodymium:yttrium-aluminum-garnet laser, argon plasma coagulation, electrocautery, nonthermal ablation with alcohol injection or photodynamic therapy, or displacement of tumor with endoscopically placed stents. Each therapy carries with it a unique profile of efficacy and complications. Some therapies may be more appropriate for certain tumor locations and morphologies than others. During the past year, new studies have defined these parameters further. However, it remains essential that the endoscopist have both a thorough knowledge of these various modalities and an ability to chose among them when undertaking endoscopic palliation of this difficult and rapidly rising disease.
Schembre
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Division of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington 98111, USA. gasdbs@vmmc.org