Endoscopic laser therapy for oesophageal cancer.

Most oesophageal cancers are incurable by the time the diagnosis is made. Treatment is therefore often palliative, and endoscopic modalities cause considerably less general upset to the patient than surgery, radiotherapy or chemotherapy. Nd:YAG laser recanalisation of advanced obstructing cancers is safe and effective for exophytic tumours that are endoscopically accessible in over 80% of cases. The risk of perforation is less than half that associated with insertion of a perforation is less than half that associated with insertion of a prosthesis, although it is higher in patients who have previously been treated by radiotherapy. After laser treatment, half the patients are able to maintain adequate nutrition until the time of their death from disseminated disease. The other half get further dysphagia due to recurrent exophytic tumour or compression from extrinsic tumour. A few develop fibrous stricturing in the laser treated area. However, many of these recurrences can be treated again with the laser or by dilation with or without a prosthesis. The quality of swallowing is better after laser treatment, as any residual oesophageal muscle function in that area can be used (not possible with a prosthesis), although several treatment sessions are usually required. In the future, the precision of laser effects may make it possible to safely ablate early tumours in their entirety.