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Endoscopic Dysphagia Treatments

Endoscopic dilation

Endoscopic dilation involves passing a tapered rubber dilator through the esophagus. Dilation is generally effective only for a short period of time, and is therefore considered a temporary means of relieving dysphagia.

Esophageal stents

Esophageal stents have been used for many years to treat dysphagia. In recent years the design of esophageal stents has improved dramatically. Stents are tubular structures that can be placed directly in the esophagus using the gastroscope and X-ray equipment. Newer stents are made of metal mesh, which is flexible yet strong. In their compressed form, stents can easily be placed in a narrow esophagus. When released, the stents expand and compress the tumor against the esophageal wall, thereby making the lumen larger. Esophageal stents can be placed as an outpatient using conscious sedation. The improvement in swallowing can last for many months and esophageal stents are considered a permanent treatment for dysphagia from esophageal cancer. Complications are uncommon, and include chest pain (usually mild), perforation of the esophagus, and migration of the stent. Infrequently, tumors grow through the stent, requiring subsequent therapies.

Laser therapy

Laser therapy is performed by passing a laser fiber through the gastroscope and aiming it at the cancer tissue. Tissue exposed to the laser is destroyed. Laser therapy is effective in relieving dysphagia, but can require multiple sessions.

Photodynamic therapy

A new technique to treat esophageal cancer is called photodynamic therapy (PDT for short). PDT is a multi-step treatment. First, the patient is injected with a photosensitizing medication. This is a simple procedure that can be performed on an outpatient basis in a matter of minutes. The medication circulates throughout the body and over the next 24-48 hours, the photosensitizer is cleared from most tissues. It will remain in higher doses in cancer tissue, liver, spleen and skin. The photosensitizer itself produces no damage to tissue. When cells containing the photosensitizer are exposed to light, however, a chemical reaction occurs which ultimately destroys the exposed tissue. In PDT for esophageal cancer, the gastroscope is used to deliver light to selectively destroy the esophageal cancer tissue. The improvement in dysphagia is noted within a few days of the treatment. Because the photosensitizer concentrates in skin, patients undergoing PDT must protect themselves from sun and bright light for at least 30 days. PDT has been compared to laser therapy and has been found to be as effective, but generally safer.