Comparative study of self-expanding metal stent and intraluminal radioactive stent for inoperable esophageal squamous cell carcinoma

Novel Prediction Score for Arterial-Esophageal Fistula in Patients with Esophageal Cancer Bleeding: A Multicenter Study

PURPOSE

To develop and internally validate a novel prediction score to predict the occurrence of arterial-esophageal fistula (AEF) in esophageal cancer bleeding.

METHODS

This retrospective cohort study enrolled patients with esophageal cancer bleeding in the emergency department. The primary outcome was the diagnosis of AEF. The patients were randomly divided into a derivation group and a validation group. In the derivation stage, a predictive model was developed using logistic regression analysis. Subsequently, internal validation of the model was conducted in the validation cohort during the validation stage to assess its discrimination ability.

RESULTS

A total of 257 patients were enrolled in this study. All participants were randomized to a derivation cohort (n = 155) and a validation cohort (n = 102). AEF occurred in 22 patients (14.2%) in the derivation group and 14 patients (13.7%) in the validation group. A predictive model (HEARTS-Score) comprising five variables (hematemesis, active bleeding, serum creatinine level >1.2 mg/dL, prothrombin time >13 s, and previous stent implantation) was established. The HEARTS-Score demonstrated a high discriminative ability in both the derivation and validation cohorts, with c-statistics of 0.90 (95% CI 0.82-0.98) and 0.82 (95% CI 0.72-0.92), respectively.

CONCLUSIONS

By employing this novel prediction score, clinicians can make more objective risk assessments, optimizing diagnostic strategies and tailoring treatment approaches.

A Functional Stent Encapsulating Radionuclide in Temperature-Memory Spiral Tubes for Malignant Stenosis of Esophageal Cancer

Stent implantation is a commonly used palliative treatment for alleviating stenosis in advanced esophageal cancer. However, tissue proliferation induced by stent implantation and continuous tumor growth can easily lead to restenosis. Therefore, functional stents are required to relieve stenosis while inhibiting tissue proliferation and tumor growth, thereby extending the patency. Currently, no ideal functional stents are available. Here, iodine-125 (125 I) nuclides are encapsulated into a nickel-titanium alloy (NiTi) tube to develop a novel temperature-memory spiral radionuclide stent (TSRS). It has the characteristics of temperature-memory, no cold regions at the end of the stent, and a uniform spatial dose distribution. Cell-viability experiments reveal that the TSRS can reduce the proliferation of fibroblasts and tumor cells. TSRS implantation is feasible and safe, has no significant systemic radiotoxicity, and can inhibit in-stent and edge stenosis caused by stent-induced tissue proliferation in healthy rabbits. Moreover, TSRS can improve malignant stenosis and luminal patency resulting from continuous tumor growth in a VX2 esophageal cancer model. As a functional stent, the TSRS combines the excellent properties of NiTi with brachytherapy of the 125 I nuclide and will make significant contributions to the treatment of malignant esophageal stenosis.

Radioactive stent insertion for inoperable hilar cholangiocarcinoma: a prospective randomized controlled trial

Introduction

Hilar cholangiocarcinoma (HC) is the leading cause of hilar biliary obstruction. Radioactive stent insertion has been utilized extensively for inoperable HC patients.

Aim

To assess the relative clinical outcomes of inoperable HC patients who underwent either normal or radioactive stent insertion.

Material and methods

This single-center, prospective, randomized, open-label study enrolled 90 inoperable HC patients from April 2021 to March 2022 and randomly assigned them to normal or radioactive stent groups (n = 45/group), with clinical data then being compared between these groups.

Results

Technical success rates in the normal and radioactive stent insertion groups were 93.3% and 97.9%, respectively (p = 1.000), and clinical success rates were similarly consistent in both groups (95.3% vs. 97.7%, p = 0.983). Individuals in the radioactive stent group exhibited significantly longer median stent patency as compared to the normal stent group (195 days vs. 115 days, p < 0.001), and median overall survival (OS) was also significantly increased in the normal stent group (242 days vs. 125 days, p = 0.002). In the normal stent insertion group, 6 (14.3%) and 5 (11.9%) patients experienced early and late postoperative complications, respectively. Additionally, early and late postoperative complications impacted 7 (16.3%) and 8 (18.6%) patients in the radioactive stent insertion group, respectively. Complication rates were comparable in these 2 patient groups.

Conclusions

Radioactive stent insertion represents a safe and effective strategy for patients with inoperable HC, potentially contributing to prolonged stent patency and OS relative to normal stent insertion.

Bilateral versus unilateral radioactive stent insertion for hilar cholangiocarcinoma

Introduction

Radioactive stent insertion (RSI) is widely used for patients with obstructive hilar cholangiocarcinoma (HC) to increase the stent patency and overall survival (OS). However, one controversy of treating HC patients is determining whether to use unilateral or bilateral stenting. General knowledge on unilateral and bilateral RSI efficacy is still lacking.

Aim

To evaluate the clinical efficacy and long-term prognoses of unilateral and bilateral RSI in HC patients.

Material and methods

Between January 2016 and December 2020, all HC patients who received unilateral and bilateral RSI at our hospital were selected for this study. We compared the treatment efficacy and long-term prognosis of patients undergoing these two procedures.

Results

Overall, 65 HC patients received either unilateral (n = 33) or bilateral (n = 32) RSI. There were no significant differences in the technical (both 100%) and functional (97.0% vs. 90.6%, p = 0.584) success rates between the 2 groups. Stent re-obstruction occurred in 6 and 9 patients in the unilateral and bilateral groups, respectively (p = 0.341). Median stent patency was 214 and 233 days in the unilateral and bilateral groups, respectively (p = 0.650). Median OS was 240 and 281 days in the unilateral and bilateral groups, respectively (p = 0.068). Lastly, the total complication rate was significantly lower in the unilateral group, as compared to the bilateral group (12.1% vs. 34.4%, p = 0.033).

Conclusions

Unilateral and bilateral RSI provided comparable clinical efficacy and long-term prognoses of HC patients. However, unilateral stenting exhibited a markedly lower complication rate.

I-125 seed-loaded versus normal stent insertion for obstructive esophageal cancer: a meta-analysis

Introduction

Malignant esophageal obstruction is usually caused by esophageal and other chest cancers. More than 80% of cases of obstructive esophageal cancer (OEC) have lost the chance of curative resection. Stent insertion is a first-line palliative approach used to treat incurable OEC.

Aim

To gauge the relative clinical efficacy of I-125 seed-loaded stent (ISS) versus normal stent (NS) insertion as a treatment for OEC.

Material and methods

Querying of the PubMed, Embase, and Cochrane Library databases was conducted to find all relevant studies published up to November 2020. The meta-analysis was undertaken using RevMan v5.3.

Results

We identified 158 studies initially, eight (4 randomized controlled trials and 4 retrospective studies) of which were used in this meta-analysis. We found that the two groups exhibited the comparable pooled Δdysphagia scores (MD = 0.02; p = 0.80), stent restenosis rates (OR = 0.97; p = 0.89), stent migration rates (OR = 0.81; p = 0.63), severe chest pain rates (OR = 1.05; p = 0.81), hemorrhage rates (OR = 1.53; p = 0.16), aspiration pneumonia rates (OR = 0.72; p = 0.38), and fistula formation rates (OR = 1.47; p = 0.44). The pooled time-to-restenosis and survival were both significantly longer in the ISS group (p = 0.04 and < 0.0001, respectively). Significant heterogeneity was detected in the endpoints of Δdysphagia scores and survival (I² = 73% and 86%, respectively). Funnel plot analysis indicated an absence of publication bias related to the selected study endpoints.

Conclusions

For patients with OEC, our meta-analysis indicated that ISS insertion could provide longer stent patency and survival than NS insertion.

Palliative radiotherapy combined with stent insertion to reduce recurrent dysphagia in oesophageal cancer patients: the ROCS RCT

BACKGROUND

Most patients with oesophageal cancer present with incurable disease. For those with advanced disease, the mean survival is 3-5 months. Treatment emphasis is therefore on effective palliation, with the majority of patients requiring intervention for dysphagia. Insertion of a self-expanding metal stent provides rapid relief but dysphagia may recur within 3 months owing to tumour progression. Evidence reviews have called for trials of interventions combined with stenting to better maintain the ability to swallow.

OBJECTIVES

The Radiotherapy after Oesophageal Cancer Stenting (ROCS) study examined the effectiveness of palliative radiotherapy, combined with insertion of a stent, in maintaining the ability to swallow. The trial also examined the impact that the ability to swallow had on quality of life, bleeding events, survival and cost-effectiveness.

DESIGN

A pragmatic, multicentre, randomised controlled trial with follow-up every 4 weeks for 12 months. An embedded qualitative study examined trial experiences in a participant subgroup.

SETTING

Participants were recruited in secondary care, with all planned follow-up at home.

PARTICIPANTS

Patients who were referred for stent insertion as the primary management of dysphagia related to incurable oesophageal cancer.

INTERVENTIONS

Following stent insertion, the external beam radiotherapy arm received palliative oesophageal radiotherapy at a dose of 20 Gy in five fractions or 30 Gy in 10 fractions.

MAIN OUTCOME MEASURES

The primary outcome was the difference in the proportion of participants with recurrent dysphagia, or death, at 12 weeks. Recurrent dysphagia was defined as deterioration of ≥ 11 points on the dysphagia scale of the European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire oesophago-gastric module questionnaire. Secondary outcomes included quality of life, bleeding risk and survival.

RESULTS

The study recruited 220 patients: 112 were randomised to the usual-care arm and 108 were randomised to the external beam radiotherapy arm. There was no evidence that radiotherapy reduced recurrence of dysphagia at 12 weeks (48.6% in the usual-care arm compared with 45.3% in the external beam radiotherapy arm; adjusted odds ratio 0.82, 95% confidence interval 0.40 to 1.68; p = 0.587) and it was less cost-effective than stent insertion alone. There was no difference in median survival or key quality-of-life outcomes. There were fewer bleeding events in the external beam radiotherapy arm. Exploration of patient experience prompted changes to trial processes. Participants in both trial arms experienced difficulty in managing the physical and psychosocial aspects of eating restriction and uncertainties of living with advanced oesophageal cancer.

LIMITATIONS

Change in timing of the primary outcome to 12 weeks may affect the ability to detect a true intervention effect. However, consistency of results across sensitivity analyses is robust, including secondary analysis of dysphagia deterioration-free survival.

CONCLUSIONS

Widely accessible palliative external beam radiotherapy in combination with stent insertion does not reduce the risk of dysphagia recurrence at 12 weeks, does not have an impact on survival and is less cost-effective than inserting a stent alone. Reductions in bleeding events should be considered in the context of patient-described trade-offs of fatigue and burdens of attending hospital. Trial design elements including at-home data capture, regular multicentre nurse meetings and qualitative enquiry improved recruitment/data capture, and should be considered for future studies.

FUTURE WORK

Further studies are required to identify interventions that improve stent efficacy and to address the multidimensional challenges of eating and nutrition in this patient population.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN12376468 and Clinicaltrials.gov NCT01915693.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 31. See the NIHR Journals Library website for further project information.

Palliative radiotherapy after oesophageal cancer stenting (ROCS): a multicentre, open-label, phase 3 randomised controlled trial

BACKGROUND

Patients with advanced oesophageal cancer have a median survival of 3-6 months, and most require intervention for dysphagia. Self-expanding metal stent (SEMS) insertion is the most typical form of palliation in these patients, but dysphagia deterioration and re-intervention are common. This study examined the efficacy of adjuvant external beam radiotherapy (EBRT) compared with usual care alone in preventing dysphagia deterioration and reducing service use after SEMS insertion.

METHODS

This was a multicentre, open-label, phase 3 randomised controlled trial based at cancer centres and acute care hospitals in England, Scotland, and Wales. Patients (aged ≥16 years) with incurable oesophageal carcinoma receiving stent insertion for primary management of dysphagia were randomly assigned (1:1) to receive usual care alone or EBRT (20 Gy in five fractions or 30 Gy in ten fractions) plus usual care after stent insertion. Usual care was implemented according to need as identified by the local multidisciplinary team (MDT). Randomisation was via the method of minimisation stratified by treating centre, stage at diagnosis (I-III vs IV), histology (squamous or non-squamous), and MDT intent to give chemotherapy (yes vs no). The primary outcome was difference in proportions of participants with dysphagia deterioration (>11 point decrease on patient-reported European Organisation for Research and Treatment of Cancer quality of life questionnaire-oesophagogastric module [QLQ-OG25], or a dysphagia-related event consistent with such a deterioration) or death by 12 weeks in a modified intention-to-treat (ITT) population, which excluded patients who did not have a stent inserted and those without a baseline QLQ-OG25 assessment. Secondary outcomes included survival, quality of life (QoL), morbidities (including time to first bleeding event or hospital admission for bleeding event and first dysphagia-related stent complications or re-intervention), and cost-effectiveness. Safety analysis was undertaken in the modified ITT population. The study is registered with the International Standard Randomised Controlled Trial registry, ISRCTN12376468, and ClinicalTrials.gov, NCT01915693, and is completed.

FINDINGS

220 patients were randomly assigned between Dec 16, 2013, and Aug 24, 2018, from 23 UK centres. The modified ITT population (n=199) comprised 102 patients in the usual care group and 97 patients in the EBRT group. Radiotherapy did not reduce dysphagia deterioration, which was reported in 36 (49%) of 74 patients receiving usual care versus 34 (45%) of 75 receiving EBRT (adjusted odds ratio 0·82 [95% CI 0·40-1·68], p=0·59) in those with complete data for the primary endpoint. No significant difference was observed in overall survival: median overall survival was 19·7 weeks (95% CI 14·4-27·7) with usual care and 18·9 weeks (14·7-25·6) with EBRT (adjusted hazard ratio 1·06 [95% CI 0·78-1·45], p=0·70; n=199). Median time to first bleeding event or hospital admission for a bleeding event was 49·0 weeks (95% CI 33·3-not reached) with usual care versus 65·9 weeks (52·7-not reached) with EBRT (adjusted subhazard ratio 0·52 [95% CI 0·28-0·97], p=0·038; n=199). No time versus treatment interaction was observed for prespecified QoL outcomes. We found no evidence of differences between trial group in time to first stent complication or re-intervention event. The most common (grade 3-4) adverse event was fatigue, reported in 19 (19%) of 102 patients receiving usual care alone and 22 (23%) of 97 receiving EBRT. On cost-utility analysis, EBRT was more expensive and less efficacious than usual care.

INTERPRETATION

Patients with advanced oesophageal cancer having SEMS insertion for the primary management of their dysphagia did not gain additional benefit from concurrent palliative radiotherapy and it should not be routinely offered. For a minority of patients clinically considered to be at high risk of tumour bleeding, concurrent palliative radiotherapy might reduce bleeding risk and the need for associated interventions.

FUNDING

National Institute for Health Research Health Technology Assessment Programme.

Clinical study of a 125I particle-integrated esophageal covered stent and hyperbaric oxygen in the treatment of advanced esophageal cancer

OBJECTIVE

this study aimed to investigate the clinical efficacy and feasibility of the treatment of advanced esophageal cancer with a combination of a 125I particle-integrated esophageal covered stent and hyperbaric oxygen.

METHODS

forty-five patients with advanced esophageal cancer were enrolled and were randomly divided into two groups: a treatment group and a control group. Patients in the treatment group were treated with a 125I particle-integrated esophageal covered stent and hyperbaric oxygen, while patients in the control group were treated with a 125I particle-integrated esophageal covered stent. The clinical effects and long-term survival time of the two groups were observed.

RESULTS

in the treatment group, the complete remission (CR) rate and partial remission (PR) rate of local lesions were 19.2 % and 61.5 %, respectively, and the total effective rate was 80.7 %. In the control group, the CR rate and PR rate of local lesions were 10.5 % and 52.6 %, respectively, and the total effective rate was 63.1 %. The total effective rate was higher in the treatment group than in the control group, which was statistically significant (p < 0.05).

CONCLUSION

the combination of a 125I particle-integrated esophageal covered stent and hyperbaric oxygen shows a good short- and long-term efficacy in the treatment of advanced esophageal cancer.

Meta-analysis of efficacy and complications of intraluminal radioactive stent and common covered stent in treatment of advanced esophageal cancer

BACKGROUND

The main symptom of advanced esophageal cancer is dysphagia. Because there is no indication for surgery, in order to improve the patient's symptoms and quality of life, esophageal stent therapy has become the main palliative treatment. Based on the results of many studies, it can be speculated that intraluminal radioactive stent is better since it combines the function of ordinary stent and brachytherapy.

AIM

To evaluate the difference in the curative effect and complications between intraluminal radioactive stent (iodine 125 particle scaffold) and common covered stent in patients with mid-advanced esophageal cancer.

METHODS

A computer search of the electronic databases PubMed (1989/2020-03), Web of Science (2000/2020-03), Wiley Online Library (1992/2020-03), CNKI database (1978/2020-03), Wanfang database (1997/2020-03), and VIP database (2000/2020-03) and a manual search of Cochrance library were performed to retrieve articles using the method recommended by the Cochrance System Evaluator's Manual (version 4.2.2). The Oxford's 2011 evidence level assessment was used to evaluate the quality of the included articles, and Meta-analysis was performed using Revman 5.3 software.

RESULTS

Ten articles were finally included, with a total of 943 patients involved. Among the patients, 449 were implanted with an intraluminal radioactive stent and 494 were implanted with a common covered stent. A meta-analysis of 10 articles showed that the average survival time of the intraluminal radioactive stent group was 3.91 mo longer than that of the common covered stent group (95%CI: 1.68-6.13, Z = 3.44, P = 0.0006), and the median survival time was 3.12 mo longer 95%CI: 1.78-4.47, Z = 4.57, P = 0.0001). The dysphagia scores of the two groups of patients were significantly reduced within 1 and 3 mo after the stent was placed (P < 0.05), but there was no statistical difference between the two groups (P > 0.05). After stenting, there was no statistically significant difference in the incidence of pain (odds ratio [OR] = 0.89, 95%CI: 0.65-1.21, Z = 0.77, P = 0.44), bleeding (OR = 0.80, 95%CI: 0.52-1.22, Z = 1.03, P = 0.30), perforation (OR = 1.16, 95%CI: 0.55-2.43, Z = 0.39, P = 0.70), or stent displacement (R = 0.66, 95%CI: 0.31-1.38, Z = 1.10, P = 0.27) between the intraluminal radioactive stent group and the common covered stent group; but there was a statistical difference in the incidence of restenosis [OR = 0.61 , 95%CI (0.42-0.87), Z = 3.73 P = 0.006] between them.

CONCLUSION

The use of intraluminal radioactive stent in the treatment of advanced esophageal cancer can prolong the average survival time and median survival time of patients, and signficantly reduce the incidence of restenosis after surgery; however, the two types of stents have no significant difference in relieving the symptoms of dysphagia within 1-3 mo or in reducing postoperative complications such as pain, hemorrhage, perforation, and stent displacement.

Case Control Study on Radioactive Stents Versus Conventional Stents for Inoperable Esophageal Squamous Cell Carcinoma

PURPOSE

The purpose of this study was to compare the relative clinical efficacy of radioactive and normal stent insertion for the treatment of inoperable obstructive esophageal squamous cell carcinoma (OESCC).

MATERIALS AND METHODS

Between January 2014 and December 2018, consecutive OESCC patients were treated via either radioactive or normal stent insertion.

RESULTS

A total of 42 and 39 OESCC patients were treated via radioactive and normal stent insertion, respectively. These procedures were both technically and clinically successful in all patients. Massive hemorrhage was observed in 7 (16.7%) and 1 (2.6%) patients in radioactive and normal stent groups, respectively (P=0.080). Median stent patency durations were 175 and 136 days in radioactive and normal stent groups, respectively (P=0.004). Median overall survival were 187 and 145 days in the radioactive and normal stent groups, respectively (P=0.011).

CONCLUSION

Relative to normal stent, radioactive stents showed a higher patency and overall survival in OESCC patients.

Self-expanding segmental radioactive metal stents for palliation of malignant esophageal strictures

BACKGROUND

Traditional metal stents are not always suitable for patients with circuitous malignant esophageal stricture.

PURPOSE

We aimed to report the safety and effectiveness of stent insertion using self-expanding segmental radioactive metal stent in the palliation of malignant esophageal stricture.

MATERIAL AND METHODS

We conducted a retrospective analysis of 22 consecutive patients who underwent insertion of segmental radioactive metal stents from November 2016 to March 2019. Technical success, dysphagia score, and complications were analyzed. Kaplan-Meier analysis was used to analyze the survival time.

RESULTS

The stenting procedure was successful in all 22 patients with no procedure-related deaths. Twenty-four segmental radioactive metal stents were successfully implanted. A total of 6 (27.3%) complications were found, mainly 5 (22.7%) stent migrations. The median follow-up period was 3.3 months. Stent removal was required in 4 (12.5%) patients due to complete stent migration. The mean dysphagia score decreased significantly after stent insertion (P<0.0001). During follow up, 13 patients survived with no obvious clinical symptom and nine patients died. The mean survival was 9.9 months.

CONCLUSION

The stenting procedure using self-expanding segmental radioactive metal stents is safe and effective in dysphagia palliation of malignant esophageal stricture.

Radioactive feeding tube in the palliation of esophageal malignant obstruction

PURPOSE

A radioactive feeding tube was used to achieve both nutrition and brachytherapy for the treatment for malignant esophageal obstruction. We report the safety and effectiveness of this technique.

METHODS

We conducted a retrospective analysis of 16 consecutive patients who employed this technique from January 2015 to March 2018. The radioactive feeding tube was made by binding the ¹²⁵I seed chain on the feeding tube. Under fluoroscopic guidance, the tube was inserted into the obstructed esophagus, with the seed chain crossing over the segment of malignant esophageal obstruction. Technical success rate, dysphagia score, procedure time and complications were analyzed. Kaplan-Meier analysis was used to analyze the survival time.

RESULTS

The radioactive feeding tube was easy to prepare. The technical success rate was 100%, without serious complications such as bleeding or infection. The median procedure time of tube insertion was 44.0 min. The Kamofsky score and Neuhaus dysphagia grading were significantly improved after tube insertion (p < 0.01). On esophageal radiography, the contrast agent passed through the narrow area smoothly. Complete remission (n = 1) and partial remission (n = 13) of local tumor were obtained in 14 patients, and the local tumor control rate was 87.5% (14/16). During follow-up, four patients survived with no obvious clinical symptom and 10 patients died of cancer. The median survival was 12.0 months.

CONCLUSION

Preparation of the radioactive feeding tube is simple and easy. The insertion of this kind of tube achieves parenteral nutrition and brachytherapy simultaneously and is safe and effective in dysphagia palliation of malignant esophageal stricture. The radiological-radiotherapeutic procedure could be an alternative tool in the case of refusing other treatments by the patients.

Massive hemorrhage from an aortoesophageal fistula caused by esophageal stent implantation: A case report and literature review

RATIONALE

Aortoesophageal fistula (AEF) is the direct communication between the aorta and esophagus, which can cause fatal hemorrhage, and its incidence increased with the use of an esophageal stent (ES).

PATIENT CONCERNS

A 79-year-old man was admitted due to hemodynamic shock with massive hematemesis caused by AEF 1 month after the implantation of an ES.

DIAGNOSES

Computed tomography angiography visualized an AEF with an ulcer-like projection on the aortic arch where the ES was placed. Angiography of the aorta revealed extravasation of contrast media from the aortic arch into the stented esophagus, which confirmed the diagnosis.

INTERVENTIONS

Thoracic endovascular aortic repair (TEVAR) was performed for massive hematemesis caused by ES-related, AEF but did not solve the underlying problem, leading to the second fatal hemorrhage.

LESSONS

TEVAR for the unique treatment of ES-related AEF is feasible in certain cases but may lead to collapse after a specific period.

History of the Use of Esophageal Stent in Management of Dysphagia and Its Improvement Over the Years

The art and science of using stents to treat dysphagia and seal fistula, leaks and perforations has been evolving. Lessons learnt from the deficiencies of previous models led to several improvements making stent deployment easier, and with some designs, it was also possible to remove the stents if needed. With these improvements, besides malignant dysphagia, newer indications for using stents emerged. Unfortunately, despite several decades of evolution, as yet, there is no perfect stent that "fits all." This article is an overview of how this evolution process happened and where we are currently with using stents to manage patients with dysphagia and with other esophageal disorders.

Interventional Therapy of Esophageal Cancer

Esophageal cancer (EC) is the fourth leading cause of cancer death in China. Despite a lot of advances in diagnosis and therapy, the survival rate of patients with EC is low. There is urgent need for a variety of methods and techniques to improve the survival time and alleviate the lesions of EC. Nowadays, alternative and less invasive approaches to the treatment of ECs are being identified. Here, we review several main interventional methods at different stages of EC, including endoscopic resection, stent placement, arterial infusion, photodynamic therapy, and radiofrequency ablation. This review will focus on the indications, methods, clinical outcomes, and complications of these methods, which may help guide the way forward.