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Endoscopic therapeutic esophageal interventions.

Cyanoacrylat and fibrin glue seem to be no better alternatives to ligation in the treatment of bleeding esophageal varices. Studies with photodynamic therapy (PDT) of high-grade dysplasia (HGD) and early esophageal cancer show encouraging results. The use of 5-aminolaevulinic acid (ALA) as a photosensitizer minimizes the rate of severe side effects, but only in HGD and tumors with a depth of 2 mm or less can a complete remission be achieved. The use of Lugol's iodine solution is sensible for the detection of HGD and early squamous cell cancers. Thermal ablation with Neodym:YAG laser and self-expanding metal stents are the most important modalities for palliative treatment of esophageal cancer.