Comparison of low-power YAG laser and BICAP tumor probe for palliation of esophageal cancer strictures.
The purposes of this study were (a) to determine the applicability of endoscopic palliation for patients with esophagogastric cancer strictures in a referral center, and (b) to compare the efficacy and safety of the BICAP tumor probe with the neodymiumyttrium-aluminum-garnet (YAG) laser for such palliation. Forty-two consecutive patients with weight loss and obstructive symptoms from an unresectable, malignant esophageal stricture were referred for endoscopic palliation. Fourteen patients did not meet the criteria for YAG laser or BICAP tumor probe treatment and other therapies were recommended. Twenty-eight patients were treated, the first 14 with low-power YAG laser and the last 14 with BICAP tumor probe. All patients had coagulation of malignant strictures in one session. Treated patients were similar in background variables and stricture lengths but twice as much thermal energy was needed for the YAG laser as the BICAP tumor probe treatment. Treatment results were not statistically different during the median follow-up and survival of 16 wk. As minor complications, either pain or edema requiring dilatation was more common in the YAG laser-treated group than the BICAP tumor probe group. Treatment-related esophageal strictures developed in 21% of patients treated with YAG laser. A fistula developed in 1 patient with noncircumferential cancer in the BICAP tumor probe group. Compared with only the intake of liquids before treatment, 86% of patients could eat a soft or solid diet after initial treatment with BICAP tumor probe or YAG laser. Our conclusions were that for BICAP tumor probe and YAG laser, endoscopic palliation efficacy and safety for circumferential esophageal cancer strictures were similar. The advantages of using the BICAP tumor probe were portability, lower equipment costs, and the ability to treat submucosal, long, or high esophageal cancer strictures in one session. Treatment with YAG laser was safer than BICAP tumor probe for exophytic, noncircumferential cancers because the laser could be directed endoscopically. Use of the BICAP tumor probe is not recommended for noncircumferential esophagogastric cancer strictures.
D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000601:surgery*; D004564:Electrocoagulation; D004938:Esophageal Neoplasms / Q000150:complications / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology / Q000601:surgery*; D004943:Esophagogastric Junction / Q000601:surgery; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D053685:Laser Therapy; D008297:Male; D010166:Palliative Care