Recent advancement of therapeutic endoscopy in the esophageal benign diseases

Abstract

Over the past 30 years, the field of endoscopy has witnessed several advances. With the advent of endoscopic mucosal resection, removal of large mucosal lesions have become possible. Thereafter, endoscopic submucosal resection was refined, permitting en bloc removal of large superficial neoplasms. Such techniques have facilitated the development of antireflux mucosectomy, a promising novel treatment for gastroesophageal reflux. The introduction and use of over the scope clips has allowed for endoscopic closure of defects in the gastrointestinal tract, which were traditionally treated with surgical intervention. With the development of per-oral endoscopic myotomy (POEM), the treatment of achalasia and spastic disorders of the esophagus have been revolutionized. From the submucosal tunnelling technique developed for POEM, Per oral endoscopic tumor resection of subepithelial tumors was made possible. Simultaneously, advances in biotechnology have expanded esophageal stenting capabilities with the introduction of fully covered metal and plastic stents, as well as biodegradable stents. Once deemed a primarily diagnostic tool, endoscopy has quickly transcended to a minimally invasive intervention and therapeutic tool. These techniques are reviewed with regards to their application to benign disease of the esophagus.

Keywords: Per-oral endoscopic myotomy, Per-oral endoscopic tumor resection, Antireflux mucosectomy, Submucosal tumors, Subepithelial tumors, Over the scope clips, Stents, Gastroesophageal reflux disease

Core tip: Antireflux mucosectomy is an endoscopic antireflux procedure showing promising results in patients with refractory gastroesophageal reflux. Over the scope clips and esophageal stents permit safe endoscopic closure of esophagogastric defects, decreasing the requirement for surgical intervention. Per-oral endoscopic myotomy allows the precise performance of endoscopic myotomy for the treatment of spastic esophageal motility disorders with the efficacy of a surgical myotomy without the associated surgical morbidity. Per-oral endoscopic tumor resection enables en bloc endoscopic removal of subepithelial tumors (SETs) and is both a diagnostic and therapeutic intervention for esophageal SETs. These techniques will expand the boundaries of therapeutic endoscopy, decrease the need for surgical intervention, and improve patient outcomes.