Palliative laser therapy of advanced esophageal carcinoma: an alternative perspective

Endoscopic Nd:YAG laser therapy was used on 91 occasions in 26 consecutive unselected patients with advanced malignant obstruction of the esophagus. Patients were treated predominantly by the retrograde method after initial esophageal dilatation. Laser therapy was effective in restoring esophageal luminal patency. However, luminal patency did not guarantee restoration of adequate oral nutritional intake. Twenty-seven percent of patients required additional nutritional support. Twenty-six percent of procedures were complicated by significant events, predominantly cardiorespiratory. Six deaths occurred within 30 days of laser therapy. Mean survival from time of first laser therapy was 16 wk. We conclude that laser therapy of malignant esophageal obstruction provides effective palliation of dysphasia; however, in older patients with advanced disease, this therapy often results in complications, as do other methods of treatment for this condition.