Oesophagogastric tumour in old age: palliative treatment by endoscopic laser photocoagulation

The results of palliative treatment, with laser photocoagulation used alone, of oesophagogastric tumours in 23 patients mean age 81.9 (range 75-93) years are reviewed. Most were frail including five with metastatic disease, seven with cardiovascular disease and five with cerebrovascular disease. Dysphagia was the presenting symptom in 21 patients, two presented with an acute haematemesis. Improvement in swallowing was achieved in 19 (90.5%). Hospital stay was minimal, and 93.3% deaths were in the community. The only complication was perforated oesophagus in 1 patient, treated successfully by conservative management. We suggest laser photocoagulation as the palliative treatment of choice for dysphagia due to oesophagogastric tumour in the frail elderly patient even when the malignancy is at an advanced stage. The major benefit of the technique is the ability to maintain patients comfortably in the community rather than committing them to terminal care in a hospital environment.