Laser therapy in maintenance of the patency of expandable metal stents

Re-establishment of the oesophageal lumen is the main focus of care in pati ents with dysphagia due to re-blockage of in situ expandable metal stent (E MS). A total of 51 patients aged 44-89 years were intubated with EMS for dy sphagia due to inoperable oesophagogastric carcinoma. Of these patients, 25 required follow-up endoscopy at variable intervals after stent insertion; 17 patients were found to have significant tumour in-growth (9), overgrowth (4) or both (4). All these patients were treated with Nd-YAG (70 W/s) or d iode laser (30-50 W, continuous) for maintenance of satisfactory swallowing . The intensity of tumour ablation was similar with both types of lasers bu t four patients being treated with Nd-YAG laser developed deformity of EMS. This complication was not encountered with diode laser. The timing of the stent insertion should be carefully chosen since the longer the stent is in situ, the greater is the likelihood of tumour ingrowth or overgrowth. The combination of endoscopic laser therapy (ELT) and EMS may offer the best pa lliation, particularly when patient survival of several months is anticipat ed. ELT can effectively deal with tumour in-growth and overgrowth but care must be exercised in the use of Nd-YAG which can damage the structure of th e EMS.