Esophageal therapeutic endoscopy, laser photocoagulation, and prosthesis

Endoscopic therapy is an established method of treatment for achalasia, benign esophageal strictures, and palliation of dysphagia due to malignancy. Endoscopic treatment options for these conditions include bougienage, balloon dilatation, injection therapy, laser treatment, and implantable endoprostheses. Recent comparative trials have yielded important information to better allow physicians to select the endoscopic treatment method best adapted to an individual clinical situation. Bougienage and balloon dilation have remained the treatment mainstays for benign strictures, whereas recent reports have added to the literature regarding steroid injection for difficult peptic or inflammatory strictures. The palliation of malignant dysphagia and treatment of esophageal fistulae have been revolutionized by the development of expandable metal stents. The efficacy and safety of pneumatic dilatation and Heller myotomy for achalasia continues to be demonstrated, but botulinum toxin injection and laparoscopic myotomy are also new treatment options. Publication of several large trials comparing endoscopic variceal sclerotherapy with band ligation plus more information regarding the use of transjugular intrahepatic portosystemic stent shunts and laparoscopic devascularization surgeries have helped clarify treatment of patients bleeding from esophageal varices.