Endoscopic laser therapy for the treatment of malignant esophageal obstruction

Malignant esophageal obstruction in 24 patients was treated using the neodymium:ytrium, aluminum, garnet laser. There were 15 males and nine females; the average age was 70.9 years. There were 17 adenocarcinomas and seven squamous cell carcinomas, with two of these being recurrent after radiation therapy. Tumor lengths ranged from 2.5-19.0 cm, with an average of 6.7 cm. The average energy delivered per centimeter of tumor was 6,309 joules for the squamous cell carcinomas and 5,598 for the adenocarcinomas. Energy delivered per treatment ranged from 3,152 to 70,527 joules. Total energy delivered per patient depended on the volume of tumor destroyed. Esophageal lumens increased from 3.4 to 16.7 mm, and 23 patients had their diets advanced, 22 to regular and one to soft solids. Reobstruction did not occur in patients who received adjunctive therapy after laser therapy. This consisted of chemotherapy in five, surgery in two, and radiation therapy in one. Complications consisted of aspiration pneumonia in three patients, including one who developed a tracheoesophageal fistula, and one documented and two suspected perforations. Hospital stay averaged 5.4 days overall and 3.5 days in those treated with the single-session technique. This increased to 8.0 days in patients with proven or suspected perforations. Endoscopic laser therapy is a safe and effective method for palliating esophageal cancer.