Endoscopic laser therapy for esophageal cancer: Present status with emphasis on past and future

Abstract

Although the major initial application for endoscopic laser therapy was for the management of gastrointestinal hemorrhage, it is now more common to use the laser endoscopically for the treatment of gastrointestinal neoplasms. A major body of literature surrounds the use of endoscopic laser therapy for esophageal cancer. The initial patient evaluation to determine if laser therapy is indicated includes a contrast radiograph, a screening endoscopy, and an imaging study. After these tests have been performed, it can be determined whether endoscopic laser therapy (ELT) is the best of the many endoscopic options. There is some difference of opinion as to the specifics of the treatment technique, and these are described. There is general agreement from reviewing the clinical data that it is possible to open the obstructed lumen in a large majority of cases and that functional success (the ability to achieve technically good results as well as clinical improvement without complications) is also possible in the majority of patients. Despite the information suggesting the benefits of ELT for esophageal cancer, there are both conceptual and technical limitations to the current approach to therapy. These limitations as well as potential future applications are discussed.

Comparative retrospective study on the use of plastic prostheses and self-expanding metal stents in the palliative treatment of malignant strictures of the esophagus and cardia

“…2,[9][10][11][12] Indications for intubation and laser therapy essentially depend on tumor morphology: a stent has to be preferred in infiltrating tumors; and a laser has to be chosen in crumbly, easily bleeding and noncircumferential neoplasms because the stent needs a good anchorage. 2,[13][14][15][16][17] Moreover, laser therapy has to be employed in tumor overgrowth of the stent and in angulated cardia strictures because the stent is horizontally positioned and the functional results are poor. 18 Only intubation can be performed in esophageal stenosis due to a bronchial carcinoma and in esophago-respiratory fistulas.…”

Laser Therapy and Insertion of Wallstents for Palliative Treatment of Esophageal Carcinoma

“…Complications such as aspiration, hemorrhage (13), and perforation (6) have been noted. The risk for perforation is reported to increase by 1 to 10% with repeated treatment (6). Also, with laser treatment alone the dysphagia-free interval is limited to a few weeks only (2,17,18).…”

“…Laser treatment alone usually requires repeated treatment at short intervals: repeat laser treatment per se carries an additional risk for the patient (6,13). Complications such as aspiration, hemorrhage (13), and perforation (6) have been noted.…”

Palliative treatment of malignant esophageal stenosis: the role of self-expanding stent endoscopic implantation

“…The indications for prosthesis placement and laser therapy are essentially down to cancer morphology: the stent has to be preferred in infiltrating tumors, whereas laser treatment is considered best for soft, non‐constricting, non‐circumferential cancers with poor anchoring capabilities 6 , 11–15 …”