Endoscopic Nd:YAG laser coagulation as palliative therapy for obstructing esophageal carcinoma

Fifteen consecutive patients who underwent endoscopic Nd:YAG laser therapy for palliation of advanced esophageal carcinoma were treated between December 1, 1983 and April 15, 1985. All but three had recurrent or persistent symptomatic disease after prior treatment with other modalities. Tumor cell type was squamous cell carcinoma in eight patients and adenocarcinoma in seven. Tumor location was distal in seven, middle in four, and upper esophagus in four. Mean tumor length was 5.6 cm and mean initial luminal diameter 2.5 mm. Twelve of 15 patients had virtually complete luminal occlusion before laser therapy. Treatment was completed in a mean of 3.47 sessions (range 2.7) over a mean of 9.18 days (range 1-18). An average of 2490 joules was delivered per session. An average of 11,695 joules was required to achieve the treatment objective of passage of a 10-mm endoscope. Mean posttreatment luminal diameter was 11.9 mm, and all but two patients noted considerable improvement in swallowing. Two patients were successfully retreated an average of 8 wk after initial laser therapy for recurrent obstruction. Two patients developed bronchoesophageal fistulae an average of 4 wk after treatment and both were successfully managed with endoscopic insertion of an esophageal prosthesis. Nd:YAG laser therapy appears to be a relatively safe and well-tolerated method to rapidly relieve luminal obstruction in patients with advanced esophageal carcinoma.