Nd-YAG laser photocoagulation in gastroenterology: Its role in palliation of colorectal cancer

Abstract

The merits of the Nd-YAG laser were evaluated in palliation of obstruction, or bleeding, or both, in 84 patients with colorectal malignancy. Luminal patency was restored in 20 of the 24 patients with obstructing colonic cancers. Haemostasis was achieved in 37 of the 40 patients with bleeding. Combined bleeding and obstruction responded favourably in 19 of the 20 patients treated. Only a few laser photocoagulation sessions, over a short period of time, were needed, and further laser treatment could be continued on an outpatient basis.

Major complications such as perforation (6), stenosis necessitating a colostomy (3), and delayed post-treatment bleeding (2) were seen in 13% of patients, with a laser-related mortality in three patients. Minor complications, such as transient stenosis (22) and laser-induced bleeding (11), responded well to further laser application. Pain and warmth (20) resolved spontaneously. Treatment failures and complications were mainly due to inadequate accessibility or were related to tissue characteristics. Laser photocoagulation appears to constitute a valuable alternative treatment, not only to resection and colostomy, in the case of obstruction, but also for haemorrhage that cannot be controlled in other ways. Palliation, in its broad sense, is guaranteed because of the rapid results, reduced time in hospital, the avoidance of hospital admission, and the good tolerance of treatment.