LASER PALLIATION OF INOPERABLE MALIGNANT DYSPHAGIA - INITIAL AND AT DEATH

Background: Nd:YAG laser therapy has been shown to be highly effective in the palliation of dysphagia due to inoperable esophageal malignanc y. However, the duration of response and the degree of palliation pres ent at death have not been adequately addressed. Methods: Seventy cons ecutive patients with inoperable malignant dysphagia (mean age, 70 yea rs; 48 men, 22 women) underwent palliative laser therapy. Dysphagia wa s assessed on a 5-point scale (0, normal; 4, complete dysphagia) befor e and after laser therapy and within 2 weeks of death. Results: Ninety -six percent of patients were palliated initially (70% successful, 26% partial). Mean swallowing score improved from 2.3 to 1.1 (p < 0.001) with a mean of 1.9 initial treatment sessions. Swallowing score remain ed improved in the last two weeks of life at a mean of 1.7 (p < 0.001) . Seventy-three percent of patients were palliated at death (36% succe ssful, 37% partial); median survival was six months. The mean total nu mber of laser sessions was 3.4, with a mean time interval between lase r sessions of 27.2 days. Complications included one perforation (1.4%) resulting in death. Conclusion: Endoscopic laser therapy provides saf e and effective initial palliation of inoperable malignant dysphagia. In the majority of patients the palliation is maintained until death.