ENDOSCOPIC LASER TREATMENT OF PROGRESSIVE DYSPHAGIA IN PATIENTS WITH ADVANCED ESOPHAGEAL-CARCINOMA

BACKGROUND/AIMS: The present study was designed to evaluate the treatm ent of malignant dysphagia by laser palliation. METHODOLOGY: Between N ovember 1994 and May 1997, 104 patients with esophageal carcinoma were subjected to endoscopic palliation with Nd-YAG laser. They were 83 me n and 21 women with mean age 57+ 6.32 years. The majority of cases (94 %) presented with difficulty in swallowing. Patients were treated at o ne-week intervals until benefit was achieved. RESULTS: A tumor mass wa s observed in the lower third of the esophagus in 15 (72%) patients. T he tumor mean length was 6 cm (range 3-10 cm). Histology revealed that 74 (71%) patients had squamous cell carcinoma and 30 (29%) patients h ad adenocarcinoma. Hospital mortality occurred in 6 (5.76%) cases beca use of esophageal perforation, fistula, or pyothorax, and late mortali ty 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) tre atment sessions. Luminal patency allowing easy passing of the endoscop e was achieved in 59 (93%) patients. Relief of symptoms and overall ou tcome improvement occurred in these patients in a relatively short tim e, there was body weight gain and an increase in serum albumin levels in 65% of patients. CONCLUSION: 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 contras t it plays a complementary role to these palliative modalities.