Endoscopic therapeutic esophageal interventions: old, new, borrowed and . . . methylene blue?

Endoscopic interventions in the esophagus continue to evolve. This article reviews some of the notable advances over the past year in endoscopic therapy for the esophagus.

In 2002 several endoscopic therapies were reintroduced or modified. Ablative treatments, including Nd:YAG laser, photodynamic therapy, and thermal contact treatments have been shown to be effective for Barrett esophagus and some early esophageal cancers. The addition of endoscopic mucosal resection may improve these therapies. Endoscopic stenting remains the dominant endoscopic palliative modality for unresectable esophageal cancers, and modifications of this therapy have focused on reducing side effects and complications. Innovations in endoscopic treatments for strictures and bleeding esophageal varices have been proposed and may improve outcomes, although probably only marginally. Additional endoscopic antireflux procedures have been introduced, although the results of long-term studies still need to be published before their place in the treatment of gastroesophageal reflux disease can be determined.

Rather than heralding novel endoscopic therapeutics, 2002 was a year of retooling and refining existing techniques.