Conventional treatment for colonic obstruction due to
cancer or benign anastomotic
strictures in high-risk patients or unresectable cases in some form of
colostomy. This procedure has the negative aspects of requiring a
general anesthetic and leaves the infirm patient with a stoma that they cannot easily attend to. Ablation of
tumor by
Nd-Yag laser has been available for several years, with passage of the
laser fiber through a
colonoscope. To evaluate the role of
laser photocoagulation in the palliation of
colorectal tumors or benign
strictures, the authors summarized their initial experience, trying to define the indications, various methods of treatment, and complication rate in these patients. This technique is difficult to perform and has the added risk of
intestinal perforation but does obviate
anesthetic and surgical risks. Seven patients with recurrent metastatic colorectal obstruction, three patients with benign colonic
strictures, and two patients with large villous
tumors were treated with
Nd-Yag laser passed via the
colonoscope. The mean age was 71 years (range, 52 to 86 years). Five patients received
sedatives only, six patients received epidural
anesthetic, and one had a
general anesthetic. The average total energy used was 3702 joules on noncontact fibers, and the average number of pulses was 126. Distance of the lesion from the anal margin ranged from 0.5 to 30 cm. Ten of twelve
tumors were within 15 cm of the dentate line. In the most distal lesions, manual debulking with biopsy
forceps facilitated the
laser treatment. Symptomatic relief was achieved in all patients. One patient required a
colostomy one month
after treatment because of incontinence. Another patient needed a resection of a benign
stricture after three
laser treatments. Other than one case of microperforation, treated conservatively with
antibiotics, no other complications occurred and there was no mortality. The authors believed that the
Nd-Yag laser plays a specific role in the treatment of high-risk patients.