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.

Long-term outcomes of per-oral endoscopic myotomy in a patient with distal esophageal spasm followed up for 2.5 years: two sides of the same coin – A Case Report and Literature Review

“…Many agents which can relax smooth muscle as PPIs, nitric oxide, calcium channel blockers, and phosphodiesterase-5 inhibitors have been routinely used. In addition, though the data does not show a clear benefit, tricyclic antidepressants, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors are also used for chest pain [13,14]. While it is clear from this case, patients with severe dysphasia and chest pain cannot tolerate oral medication.…”

The first experience in the use of a circular cylinder in Ukraine for endoscopic radiofrequency ablation at Barrett›s esophagus

“…Учитывая трудоёмкость и травматичность подобного исследования, его высокую стоимость, а также риски пропуска микроскопических диспластических изменений слизистой оболочки при эндоскопическом исследовании и при изучении микропрепаратов, особенно в случаях длинного сегмента ПБ, для снижения риска аденокарциномы пищевода ЭРЧА может применятся и у этой группы пациентов. Для чего могут использоваться секторальные и циркулярные датчики (90 и 360 градусов) [1][2][3][4][5][6].…”

Quantifying optical properties with visible and near-infrared optical coherence tomography to visualize esophageal microwave ablation zones

“…Suspected lesions are evaluated with both endoscopy and endoscopic biopsy to diagnose the abnormal region as no dysplasia, low-grade dysplasia, high-grade dysplasia, or intramucosal carcinoma. In the case of high-grade dysplasia and intramucosal carcinoma, endoscopic resection is used to remove lesions followed by endoscopic radiofrequency ablation (RFA) to ensure total destruction of malignant tissue [2]. However, there has been high variability in RFA success rates for treatment of intestinal metaplasia or BE [3].…”