Endoscopic Nd-YAG laser therapy for palliation of upper gastrointestinal malignancy.
Endoscopic laser therapy with the neodymium-yttrium-aluminium-garnet (Nd-YAG) laser has been shown to provide good palliation of upper gastrointestinal obstruction caused by malignancy, and to be associated with a low morbidity and a low mortality rate. Fifty patients with inoperable upper gastrointestinal malignancy have been treated with this method: 22 had oesophageal carcinoma, 16 adenocarcinoma at the cardio-oesophageal junction, two carcinoma of the antrum and 10 recurrent tumours at the site of previous anastomoses. The main symptoms were dysphagia in 40 and vomiting in seven; three others had recurrent bleeding. An Nd-YAG laser was used to photocoagulate the tumours using power levels of 50-100 W and an average energy output per treatment of 10,000 J. Thirty patients (75%) with dysphagia improved with treatment but vomiting was relieved in only three of the seven patients with this symptom. Complications were infrequent--two patients (4%) developed a perforation and one had a respiratory arrest which was reversible. The 30-day mortality rate was 14% with 2% being related to the procedure. Endoscopic Nd-YAG laser therapy is an acceptable alternative to the more established methods of palliation such as surgical or endoscopic intubation.
Gastroenterology/Liver Unit, Sir Charles Gairdner Hospital, Nedlands, WA.
F N
FN
Brennan
J H
JH
McCarthy
B H
BH
Laurence
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D002423:Cause of Death; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D004943:Esophagogastric Junction; D004945:Esophagoscopy / Q000379:methods; D005069:Evaluation Studies as Topic; D005260:Female; D005743:Gastrectomy; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D010166:Palliative Care / Q000379:methods; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*