Laser recanalization of obstructing foregut cancer

Abstract

Palliative treatment of upper gastrointestinal tract obstruction was undertaken by endoscopic laser therapy in 6 patients with carcinoma of the oesophagus or stomach. All had dysphagia for solids on admission and were considered unsuitable for surgery or radiotherapy. Three were in sites unsuitable for placement of an endoscopic prosthesis. The tumours occluded up to 90 per cent of the lumen (2 squamous and 4 adenocarcinomas). Treatment was carried out under direct vision, the laser wave guide being passed through the biopsy channel of a standard endoscope. Superficial tumour vaporized immediately using energies of 2-10 000 J per session, whereas deeper layers sloughed over the succeeding 2-3 days. Two to six treatments were required to relieve dysphagia and there were no major complications. Quantitative barium studies before and after treatment showed a significant increase in luminal diameter. These patients could eat solid food after treatment and all were able to go home.

Low-power laser therapy for gastrointestinal neoplasia

“…[10][11][12][13] About 20% of patients complain of chest pain with a burning sensation during or after high-power laser therapy. 1,4,9,19 Our study and other reports 10,25 found that patients had less pain with a low-power contact laser. Acute perforation was a severe complication in 4% of patients receiving high-power laser therapy.…”

“…The effective rate of palliative treatment of malignant stenosis varies from 80% to 100%. [1][2][3][4][5][6][7][8][9][19][20][21][22][23][24] The degree of penetration and the course of destruction of GI tumors by high-power noncontact laser or electrical surgery cannot be precisely predicted. [10][11][12][13]25 The preliminary outcome of laser treatment with the low-power contact method has been, encouragingly, as effective as that of high-power laser treatment, with a low risk of complications.…”

“…There are a number of suggested therapeutic indications for neodymium yttrium aluminum garnet (Nd:YAG) laser in the management of GI problems, including ulcer hemostasis, tumor removal, and recanalization of tumor obstruction. Endoscopic high-power laser therapy has had palliative effects by recanalizing tumor-induced stenosis [3][4][5][6][7][8][9] and curing small lesions. However, many disadvantages, such as chest discomfort or pain during laser treatment, and the high cost of the procedure, need to be resolved.…”

Laser and photodynamic therapy of esophageal cancer

“…Patients are also intensively counseled to remain out of reflected or direct sunlight for 1 month as such exposure could lead to very serious sunburn reactions. At 1 month, patients can carefully test their skin reaction to sunlight over [5][6][7][8][9][10][11][12][13][14][15] minute intervals and if no sunburn occurs, exposure to sunlight is permitted.…”

Hidden Loop Jejunostomy – An Experimental Model

“…Feeding, therefore, becomes a major problem. Current therapy includes endoscopic intubation [9], laparot omy for tumor bypass, feeding gastrostomy or feeding jejunostomy, and laser recanaliza tion [11].…”