Endoscopic laser therapy of malignant esophageal obstruction

Malignant esophageal obstruction in patients with carcinoma of the esophagus and adenocarcinoma of the distal esophagus usually indicates far-advanced disease. Palliative therapy with the neodymium-yttrium, aluminum, garnet laser has been proposed as an alternative to more invasive procedures that do little to improve the quality of life or prolong survival. Fifteen patients were treated with endoscopic laser therapy. A previously described technique was used to treat the first ten patients; the remaining five were treated with a single-session therapy method. This new technique allowed more rapid completion of therapy (1.4 treatments over 2.2 days vs 2.9 treatments over 7.8 days) without sacrificing safety. Single session therapy using this laser is recommended as the treatment of choice in patients with carcinoma of the esophagus with obstruction that is surgically or radiotherapeutically incurable.