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Endoscopic Nd‐YAG laser therapy for palliation of upper gastrointestinal malignancy

Endoscopic laser therapy with the neodymium‐yttrium‐aluminium‐garnet (Nd‐YAG) laser has been shown to provide good palliation of upper gastrointestinal obstruction caused by malignancy, and to be associated with a low morbidity and a low mortality rate. Fifty patients with inoperable upper gastrointestinal malignancy have been treated with this method: 22 had oesophageal carcinoma, 16 adenocarcinoma at the cardio‐ oesophageal junction, two carcinoma of the antrum and 10 recurrent tumours at the site of previous anastomoses. The main symptoms were dysphagia in 40 and vomiting in seven; three others had recurrent bleeding. An Nd‐YAG laser was used to photocoagulate the tumours using power levels of 50‐100 W and an average energy output per treatment of 10 000 J. Thirty patients (75%) with dysphagia improved with treatment but vomiting was relieved in only three of the seven patients with this symptom. Complications were infrequent — two patients (4%) developed a perforation and one had a respiratory arrest which was reversible. The 30‐day mortality rate was 14% with 2% being related to the procedure. Endoscopic Nd‐YAG laser therapy is an acceptable alternative to the more established methods of palliation such as surgical or endoscopic intubation.