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Over a 14-year period, 746 patients were treated at the Lille Laser Center for rectosigmoid tumor. Two hundred seventy-two patients were treated for palliation of symptoms from rectosigmoid cancer and 474 patients were treated for a benign rectosigmoid villous adenoma. The immediate success rate and complication rate were 85% and 2%, respectively, for patients with advanced cancer, and 92.8% and 1.8% for those with a villous adenoma. Patients with an advanced cancer remained functionally improved during a 10.1-month average period after initial improvement. The recurrence rate after initial treatment for villous adenomas was 18% during a 29.7-month average follow-up. Immediate results were influenced by reason for treatment, initial symptoms, and circumferential extension for patients with a cancer, and only by circumferential extension for patients with a villous adenoma. Long-term results were influenced by reason for treatment and circumferential extension for patients with cancer, and by reason for treatment, initial histology and localization for patients with a villous adenoma. Laser treatment provided relief of symptoms in inoperable patients with advanced rectosigmoid carcinomas. Because treatment is long and difficult and the cancer rate is high, endoscopic laser should be limited in patients with a circumferential villous adenoma to non-surgical candidates. The risk of complication after surgery (some being fatal) has to be balanced against the risk of undetected carcinoma and the indication for endoscopic laser treatment should be discussed case by case.

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This prospective non-randomised trial of 128 selected patients with unresectable oesophageal or gastrooesophageal junction cancers aims to evaluate the initial relief of malignant obstruction by means of bipolar electrocoagulation for both circumferential and submucosal strictures of Nd:YAG laser for the other patients. A limited dilatation was performed initially if a small calibre endoscope was unable to pass through the stricture. Prompt and significant relief ofdysphagia without complications was achieved in 83% of patients. Improved patients were retreated monthly during the follow up period. Radiotherapy was recommended when possible.