THERAPEUTIC ENDOSCOPY IN THE ESOPHAGUS

Therapeutic endoscopy has become a well-accepted treatment method for achalasia, benign esophageal strictures, and palliation of malignant dysphagia. For these indications, a variety of complementary or competitive procedures such as bougienage, balloon dilatation, injection therapy, laser treatment, and the implantation of endoprostheses are available. The selection of the different techniques can be increasingly better adapted to the individual clinical situation on the basis of comparative trials. However, the availability of local expertise appears to remain an important factor in therapeutic decision making. For the treatment of benign strictures bougienage and balloon dilatation seem to be comparably effective and safe. The palliation of malignant dysphagia requires expertise in laser treatment, endoscopic intubation, and radiotherapy. The indication of the exclusive or combined application of these methods depends on the condition of the patient, and the type, site, and extension of the esophagogastric tumor. A significant improvement in the treatment of malignant esophageal stenoses and esophagorespiratory fistulas can be expected with the use of covered self-expanding esophageal stents.