Twenty-eight patients with 29 benign and 25 malignant neoplasms of the gastrointestinal tract were treated with endoscopically-directed Argon and Nd:YAG lasers. Purposes of laser treatment were for removal of neoplastic tissue, restoration of lumenal patency and control of hemorrhage.
Argon laser was applied at 3-5 watts with pulse durations up to 10 seconds. Nd:YAG laser was applied at 50-80 watts and pulse durations up to 2.0 seconds. The Argon laser was used for small benign polyps, whereas Nd:YAG was applied to larger polyps and cancers. Treatments were begun centrally, progressing toward the periphery until the tumor tissue appeared white or gray. Multiple treatments spaced at 2-4 day intervals, were usually necessary for malignant tumors. For obstructing cancers, mechanical debridement was used prior to the second and each subsequent laser treatment.
Twenty-six benign colonic polyps were completely removed with Argon laser. One large rectal tubulovillous adenoma recurred, and its removal was completed with Nd:YAG laser. Two gastric adenomas recurred despite Argon and Nd:YAG treatments; surgical excision was ultimately required.
Nineteen patients with advanced, disseminated or unresectable cancers received palliative Nd:YAG laser treatments. Obstruction was relieved in 11 of 12 patients with esophageal (9), gastric (1), biliary (1) and colonic (1) carcinomas. Acute hemorrhage was controlled in 5 patients but recurred in 2 patients, 19 and 49 days later. Additional treatments were required. Three persons with disseminated rectal cancer, without bleeding or obstruction, received Nd:YAG laser treatments to the primary cancer in the hope that local complications would be prevented. None developed bleeding or obstruction, but mean survival was short, only 18.7 weeks.
Four patients had early, well localized rectal cancers and were selected for laser treatment because surgery was not feasible. In all four patients, all visible tumor was removed with the Nd:YAG laser. Three patients died of cardiovascular disease 17, 19 and 29 weeks following laser treatments. The fourth patient was alive, without recurrence, 19 months later.
Complications of laser treatment were infrequent but included esophagotracheal fistula (2) and pleural effusion (1). There were no deaths attributable to laser treatments.
We conclude that Argon and Nd:YAG lasers are useful in selected patients for the removal of benign, sessile colonic adenomas and for the palliation of local complications (obstruction, bleeding) of enteric cancer. Laser therapy may provide cure for some patients in whom surgical excision seems ill-advised.