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Current treatment options for esophageal diseases

J. Martínek, JI. Akiyama, Z. Vacková, M. Furnari, E. Savarino, TJ. Weijs, E. Valitova, S. van der Horst, JP. Ruurda, L. Goense, G. Triadafilopoulos,

. 2016 ; 1381 (1) : 139-151. [pub] 20160708

Language English Country United States

Document type Journal Article, Review

Persistent link   https://www.medvik.cz/link/bmc17031346

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.

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$a Exciting new developments-pharmacologic, endoscopic, and surgical-have arisen for the treatment of many esophageal diseases. Refractory gastroesophageal reflux disease presents a therapeutic challenge, and several new options have been proposed to overcome an insufficient effectiveness of proton pump inhibitors. In patients with distal esophageal spasm, drugs and endoscopic treatments are the current mainstays of the therapeutic approach. Treatment with proton pump inhibitors (or antireflux surgery) should be considered in patients with Barrett's esophagus, since a recent meta-analysis demonstrated a 71% reduction in risk of neoplastic progression. Endoscopic resection combined with radiofrequency ablation is the standard of care in patients with early esophageal adenocarcinoma. Mucosal squamous cancer may also be treated endoscopically, preferably with endoscopic submucosal dissection. Patients with upper esophageal cancer often refrain from surgery. Robot-assisted, thoracolaparoscopic, minimally invasive esophagectomy may be an appropriate option for these patients, as the robot facilitates a good overview of the upper mediastinum. Induction chemoradiotherapy is currently considered as standard treatment for patients with advanced squamous cell carcinoma, while the role of neoadjuvant therapy for adenocarcinoma remains controversial. A system for defining and recording perioperative complications associated with esophagectomy has been recently developed and may help to find predictors of mortality and morbidity.
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$a Akiyama, Jun-Ichi $u Division of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan. $7 gn_A_00002977
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$a Vacková, Zuzana $u Department of Hepatogastroenterology, IKEM, Prague, Czech Republic.
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$a Furnari, Manuele $u Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy.
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$a Savarino, Edoardo $u Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
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$a Weijs, Teus J $u Department of Surgery, Diakonessenhuis Utrecht, Utrecht, the Netherlands.
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$a Valitova, Elen $u Department of Upper Gastrointestinal Tract Disorders, Clinical Scientific Centre, Moscow, Russia.
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