Palliative laser therapy for malignant dysphagia

Seventy six patients with dysphagia caused by malignant tumours of the oesophagus or gastric cardia have been treated using the Neodymium Yttrium Aluminium Garnet (NdYag) laser. The laser was set to deliver 80-100 watts of power for 0.5-1 second pulses. To obtain improvement, patients on average needed four treatment sessions with a mean energy per treatment of 3586 joules. Follow up endoscopy and laser treatment was at four week intervals, unless the clinical or endoscopic results indicated otherwise. The immediate result was to allow 32% of patients to swallow anything they liked, a further 54% were able to take most solids and 9% were improved, or maintained on liquids only. The mortality of laser recanalisation and associated treatment was 5%. The improvement in swallowing was maintained until death in all but 15% of these patients, some of the 15% needed intubation to allow adequate swallowing. Endoscopic, or surgical intubation was required immediately in five patients after an initial laser course failed to provide improvement. The mean survival of the whole group was 19 weeks (range one to 112 weeks).