Low-power laser therapy for gastrointestinal neoplasia

The purpose of this study was to evaluate changes in the degree of neoplasi a-induced stenosis and clinical symptoms before and after therapy with a co ntact low-power neodymium yttrium aluminum garnet (Nd:YAG) laser. Fifty pat ients with pathologically proven gastrointestinal (GI) neoplasia were studi ed; 21 with benign lesions and 29 with malignant tumors. The low-power cont act Nd:YAG laser was applied toward the lesion, using an antegrade method a s the scope was moved circumferentially and downward along the length of th e lesions, step-by-step. The energy of the laser was 20 W, with a duration of 1 to 2 min for each shot. Either the tumor was eradicated completely, or the neoplasia-induced stenosis was recanalized by laser via the endoscope. All benign lesions were completely remitted by laser therapy. The clinical symptoms in the 29 patients with malignant GI neoplasia showed a significa nt improvement (P < 0.001; Wilcoxon matched-pairs signed-rank test, one-tai led) after laser therapy in comparison with the symptoms before treatment. Malignant GI stenosis treated by laser resulted in recanalization in 93.1% of the 29 patients. Unfortunately, in 1 patient with gastric cancer, the di sease progressively worsened after treatment. One of 3 patients with early cancer of the stomach who received laser therapy was found to have distant metastasis 2 years later. A patient with esophageal cancer developed an eso phagobronchial fistula that was not a direct complication of the laser effe ct. Four patients with malignancies died of cancer progression during the 2 years of follow-up. We conclude that the low-power contact laser is a safe , convenient method for the treatment of both benign and malignant tumors. Patients with advanced obstructive lesions have a better quality of life af ter laser therapy.