Recent work in therapeutic endoscopy of nonvascular diseases of the esophagus continues to focus on dilatation or stenting of stenoses and ablation of metaplastic or neoplastic tissue. For individual indications, the selection of the optimal treatment can be difficult in view of a plethora of alternative procedures and a limited number of comparative trials. Dilatation can be considered the first-line method for achalasia because of excellent long-term results and a low number of major complications that can be safely and durably treated by surgery. Bougienage and pneumatic dilatation seem to be equally effective for various types of benign strictures. The latest techniques do not require routine fluoroscopic control. Laser photoablation of Barrett's epithelium leading to restoration of squamous mucosa is an exciting new tool for research. Photodynamic therapy can achieve complete ablation of early esophageal adenocarcinoma in selected cases, but it does not seem to offer major advantages over thermal laser therapy for advanced tumor stages. Self-expandable metal stents rapidly achieve recanalization of obstructing esophageal malignancies with a minimally invasive approach. Considerable long-term complications may be overcome by covered stents, which are especially useful for occlusion of esophagorespiratory fistulas.
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