Water jet guided Nd:YAG laser coagulation--its application in the field of gastroenterology

With the water jet guided laser, a comparatively new transmission system has become available, with the aid of which the laser beam is conducted from the end of the transmission fibre of the conventional light guide system to the target tissue via a water jet. The extra costs of this modality are low. The technique is easy to apply, and is associated with a number of technical advantages, such as absence of smoke and carbonisation, reduction in organ distension, etc. The water jet guided laser brings about volume coagulation in the deeper layers of the wall, with concomitant oedema and hyperaemia in the periphery. In a randomised, prospective controlled study, 89 patients with gastroduodenal ulcers bearing a visible vessel were treated with the Nd:YAG laser (wavelength 1.064 nm), 43 with the non-contact, and 46 with the water jet guided modality. In the water jet group a smaller number of bleedings were induced (p < 0.05) and fewer failures, emergency operations and deaths occurred. The technical advantages of the method, together with the results of treatment in 20 tumour patients with adenomas (n = 6) and adenocarcinomas in the colorectum (n = 14) with readily achievable tumour debulking (n = 13) or complete eradication (n = 7), suggest that the use of the water jet guided laser might also be appropriate for the treatment of tumours.