Analysis of failures and complications of neodymium: YAG laser photocoagulation in gastrointestinal tract tumors. A retrospective survey of 18 years' experience.
Eight years of experience with endoscopic Nd:YAG laser photocoagulation were analyzed in retrospect in an attempt to identify factors relating to both failures and complications of laser therapy, and to delineate its limits and pitfalls in benign and malignant tumors. Three hundred and seventy-eight patients were studied, including 42 with gastroesophageal cancer, 180 with colorectal adenoma and 156 with colorectal malignancy. Patients with gastroesophageal cancer (n = 42) were referred mainly for obstruction in esophageal cancer and for bleeding in gastric cancer, with successful palliation in 86 and 81%. Hemorrhage was the only complication seen, twice during and twice after treatment. Pain, heat and smoke-induced complaints and sometimes temporary increased dysphagia were mentioned. Two white-surfaced tumors did not react at all. Patients with colorectal adenoma (n = 150) were divided into groups according to the size of the lesion. Definitive, histologically documented eradication of adenomatous tissue was achieved in 43% of the extensive, in 69% of the intermediate, and in 97% of the small adenomas. Major complications, mainly stenosis and hemorrhage, occurred in 6.4%, 7.6% and none of the lesions, respectively, and minor complications were seen in 57.4, 30.8 and 13.8%, respectively. Stenosis appeared to be related only to prior electrocoagulation and to excessive delivery of energy. Post-treatment hemorrhage occurred at about day 7. In familial polyposis (n = 30) surveillance of the rectal stump was successful in 84%, with major and minor complications in 4% and 12%. In colorectal cancers (n = 156) treated for palliation of bleeding and obstruction, success was obtained in 91%. major complications (13%) consisted mainly of stenosis and perforation.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Gastroenterology and Hepatology, University of Amsterdam.
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Mathus-Vliegen
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Tytgat
D000236:Adenoma / Q000601:surgery; D002277:Carcinoma / Q000601:surgery; D015179:Colorectal Neoplasms / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology; D007834:Lasers / Q000009:adverse effects; D008028:Light Coagulation / Q000009:adverse effects; D010166:Palliative Care; D012189:Retrospective Studies