title: Current treatment options for esophageal diseases.
abstract: Exciting new developments-pharmacologic, endoscopic, and surgical-have arisen for the treatment of many esophageal diseases. Refractory gastroesophageal reflux disease presents a therapeutic challenge, and several new options have been proposed to overcome an insufficient effectiveness of proton pump inhibitors. In patients with distal esophageal spasm, drugs and endoscopic treatments are the current mainstays of the therapeutic approach. Treatment with proton pump inhibitors (or antireflux surgery) should be considered in patients with Barrett's esophagus, since a recent meta-analysis demonstrated a 71% reduction in risk of neoplastic progression. Endoscopic resection combined with radiofrequency ablation is the standard of care in patients with early esophageal adenocarcinoma. Mucosal squamous cancer may also be treated endoscopically, preferably with endoscopic submucosal dissection. Patients with upper esophageal cancer often refrain from surgery. Robot-assisted, thoracolaparoscopic, minimally invasive esophagectomy may be an appropriate option for these patients, as the robot facilitates a good overview of the upper mediastinum. Induction chemoradiotherapy is currently considered as standard treatment for patients with advanced squamous cell carcinoma, while the role of neoadjuvant therapy for adenocarcinoma remains controversial. A system for defining and recording perioperative complications associated with esophagectomy has been recently developed and may help to find predictors of mortality and morbidity.
authors.affiliation: Department of Hepatogastroenterology, IKEM, Prague, Czech Republic. jan.martinek@volny.cz.
authors.forename: Jan
authors.initials: J
authors.lastname: Martínek
authors.affiliation: Division of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Jun-Ichi
authors.initials: JI
authors.lastname: Akiyama
authors.affiliation: Department of Hepatogastroenterology, IKEM, Prague, Czech Republic.
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Vacková
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy.
authors.forename: Manuele
authors.initials: M
authors.lastname: Furnari
authors.affiliation: Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Savarino
authors.affiliation: Department of Surgery, Diakonessenhuis Utrecht, Utrecht, the Netherlands.
authors.forename: Teus J
authors.initials: TJ
authors.lastname: Weijs
authors.affiliation: Department of Upper Gastrointestinal Tract Disorders, Clinical Scientific Centre, Moscow, Russia.
authors.forename: Elen
authors.initials: E
authors.lastname: Valitova
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Sylvia
authors.initials: S
authors.lastname: van der Horst
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Jelle P
authors.initials: JP
authors.lastname: Ruurda
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Lucas
authors.initials: L
authors.lastname: Goense
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University, Stanford, California.
authors.forename: George
authors.initials: G
authors.lastname: Triadafilopoulos
mesh_terms: D000818:Animals; D001471:Barrett Esophagus / Q000175:diagnosis / Q000628:therapy; D004935:Esophageal Diseases / Q000175:diagnosis* / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000628:therapy; D016629:Esophagectomy / Q000379:methods* / Q000639:trends; D004945:Esophagoscopy / Q000379:methods / Q000639:trends; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors
keywords: Barrett's esophagus; distal esophageal spasm; esophageal carcinoma; esophagectomy; gastroesophageal reflux disease