Endoscopic laser treatment for early gastric cancer

Endoscopic laser treatment (ELT) has been proposed as one of the curative endoscopic therapies for early gastric cancer. We report our experience with ELT in 111 patients with early gastric cancer limited to the mucosa as diagnosed by endoscopy and/or endoscopic ultrasonography. Twelve patients subsequently underwent laparotomy after ELT and no residual tumor was found in 75% of these cases. Ninety-nine patients had no surgery for various reasons and follow-up information by endoscopy was available for 73 of them for a mean of 2.7 years (range 1 to 7 years). 81% of these patients were found to be tumor free. There was no difference in the success rate of ELT in relation to endoscopic classification, tumor location and histologic type of cancer. Recently, the indications for ELT decreased due to the development of endoscopic mucosal resection (EMR) enabling histological evaluation of a resection specimen. However, the technique of EMR cannot always be performed completely depending on the location and size of the lesions. Therefore, we employed ELT as an additional treatment technique after EMR therapy to achieve complete tumor destruction. Results in 13 patients where both techniques were employed showed complete tumor removal in 11 cases. At present, this combined application may be the most important role of laser irradiation for the treatment of early stage GI tract malignancies.