Palliative therapy of upper gastrointestinal malignancies using the Nd-YAG laser

The principal role of the Neodymium yttrium aluminum garnet (Nd-YAG) laser has been to alleviate obstruction and to arrest hemorrhage secondary to metastatic or locally unresectable malignant lesions throughout the gastrointestinal (GI) tract. Between June 1985 and December 1988, 26 patients have been treated for advanced upper GI malignancy: 20 obstructing esophageal carcinomas (three proximal, eight middle, and nine distal third); two prepyloric obstructing and one bleeding gastric lesion; one bleeding pancreatic carcinoma eroding into the duodenum; and two primary duodenal lesions (one partially obstructing and one bleeding). The dysphagia grade improved in all patients with esophageal carcinoma, but less so for those with proximal tumors. The obstructing gastric lesions were recanalized and bleeding was arrested. The pancreatic and duodenal lesions were successfully managed with one treatment. There were no perforations or other laser-related complications. The approaches to palliation must be conceived in a fashion to improve the quality of life with minimal risk and discomfort. Although ultimate survival is determined by the stage of the disease, the Nd:YAG laser can restore gastrointestinal continuity and, in so doing, significantly palliate the patient.