Endoscopic ablation of esophageal malignancies with the neodymium-YAG laser and electrofulguration

H. R. Nava, M. E. Schuh, R. Nambisan, J. L. Clark and H. O. Douglass Jr
Department of Surgery, Roswell Park Memorial Institute, Buffalo 14263.

The case reports of 40 patients with obstructive esophageal cancer treated with electrofulguration (EF) or neodymium (Nd)-YAG laser were reviewed. Surgery was contraindicated because of advanced carcinoma (17 patients), recurrence after resection (13 patients), recurrence after irradiation (four patients), and poor medical condition (four). Two patients refused surgery. There were 31 men and four women; mean age was 62 years. There were 31 adenocarcinomas, eight squamous cell carcinomas, and one metastatic breast carcinoma. Tumor locations were lower esophagus in 35 patients, middle esophagus in three, and cervical esophagus in two. Thirty-five patients had obstructions; two, bleeding, and three, both. None of the patients could swallow solids. A total of 255 treatments were given (mean, 6.6 per patient). The mean number of Nd-YAG treatments was 1.9; for EF, 1.3. All 40 patients tolerated solid food after treatment and the esophagus remained open from three to 14 weeks. Mean survival from first treatment was 11 months; from diagnosis, 17 months. Both techniques were safe and effective.