Endoscopic laser treatment of progressive dysphagia in patients with advanced esophageal carcinoma

The present study was designed to evaluate the treatment of malignant dysphagia by laser palliation.

Between November 1994 and May 1997, 104 patients with esophageal carcinoma were subjected to endoscopic palliation with Nd-YAG laser. They were 83 men and 21 women with mean age 57+ 6.32 years. The majority of cases (94%) presented with difficulty in swallowing. Patients were treated at one-week intervals until benefit was achieved.

A tumor mass was observed in the lower third of the esophagus in 75 (72%) patients. The tumor mean length was 6 cm (range 3-10 cm). Histology revealed that 74 (71%) patients had squamous cell carcinoma and 30 (29%) patients had adenocarcinoma. Hospital mortality occurred in 6 (5.76%) cases because of esophageal perforation, fistula, or pyothorax, and late mortality occurred in 29 (27.9%) patients. Perforation occurred in 5 (4.8%). Improvement in dysphagia occurred after a mean of 3.3 (range 1-13) treatment sessions. Luminal patency allowing easy passing of the endoscope was achieved in 59 (93%) patients. Relief of symptoms and overall outcome improvement occurred in these patients in a relatively short time, there was body weight gain and an increase in serum albumin levels in 65% of patients.

In conclusion, control of dysphagia by laser palliation suggests that endoscopic laser therapy should not be regarded as being in competition with other treatment techniques such as surgery, radiation, chemotherapy, dilatation or stents, in contrast it plays a complementary role to these palliative modalities.