Endoscopic Nd:YAG laser therapy of malignant esophageal obstruction on an outpatient basis.

Between May 1985 and December 1988, 41 patients were treated palliatively with endoscopic neodymium:yttrium-aluminum-garnet laser therapy for obstruction of the esophagus by malignant disease. All were considered incurable, because they presented with distant metastases, severe systemic disease, extensive local disease or recurrent disease. Thirty-nine percent were managed as outpatients; the remainder required admission to hospital. Sixty-three percent of the outpatients had adenocarcinoma, and 31% had squamous cell carcinoma; over 90% of the tumours were less than 8 cm long, and 63% were in the distal one-third of the esophagus or the cardia. Forty-four percent of the inpatients had adenocarcinoma, and 44% had squamous cell carcinoma; in this group, over 90% of the tumours were less than 8 cm long, and 56% were in the distal one-third of the esophagus or the cardia. The mean number of sessions and laser energy administered were 2.6 and 4949 J for outpatients and 2.7 and 4974 J for inpatients. Palliation of dysphagia was good to excellent in all outpatients but was not as good for the inpatient group, in which one major complication occurred. The mean length of survival for outpatients and inpatients was 6.3 months (range from 1 to 16 months) and 3.9 months (range from 1 to 18 months) respectively.