Laser therapy, on the other hand, offers 100 percent chance for success, with a 3.6 percent complication rate and approximately 1 percent mortality when performed by experienced practitioners. Laser is also considered better for high esophageal obstruction, where plastic prostheses such as Celestin's tubes cannot be fitted.
Endoscopic Laser Treatment Pretreatment evaluation will again involve mapping the exact geometry of the tumor and staging the disease. The size, depth of penetration of tumor invasion and lymph node status will determine whether the tumor is operable.
In the procedure itself (YAG laser with or without hematoporphyrin), the endoscope will be passed through your mouth and down the esophagus to the tumor site. Only the top layers of the treated area will be affected and only small pieces of tissue will evaporate. Three or more sessions might be needed to achieve an opening. These sessions are often spaced at 48-hour intervals to allow tissue breakdown to be more complete and to give the patient a rest. The technique varies and is decided upon by the operator. He or she will usually treat the lowest part of the tumor first, then come higher with each treatment session.
• Lasers are most useful in the middle and lower esophagus, which is straight, and least valuable for tumors
outside the esophageal wall.
• It is difficult to know how deep to go into the submucosa since there are no good landmarks.
