The purpose of this study was to evaluate changes in the degree of
neoplasia-induced
stenosis and clinical symptoms before and after
therapy with a contact low-power
neodymium yttrium aluminum garnet (
Nd:YAG) laser. Fifty patients with pathologically proven gastrointestinal (GI)
neoplasia were studied; 21 with benign lesions and 29 with malignant
tumors. The low-power contact
Nd:YAG laser was applied toward the lesion, using an antegrade method as the scope was moved circumferentially and downward along the length of the lesions, step-by-step. The energy of the
laser was 20W, 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 significant improvement (P < 0.001; Wilcoxon matched-pairs signed-rank test, one-tailed) 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 disease 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 esophagobronchial
fistula that was not a direct complication of the
laser effect. 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 after
laser therapy.