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Endoscopic laser photocoagulation is a very effective means of treating oesophageal dysphagia due to malignancy. The Nd:YAG (neodymium-yttrium aluminium garnet) laser is most commonly used within the 60-100W power range; it is transmitted down a flexible endoscope channel. Carbon dioxide is also passed down the tube to dislodge combustible material from the target area.
The laser may approach the tumour from either proximal or distal edges - beyond the stenosis. The heat created is sufficient to 'cut' through the tumour thickness.
Complications of Nd:Yag photocoagulation include perforation, haemorrhage and sepsis. However, perforation occurs at a lower incidence than for stenting or stricture dilatation.
Although at an early stage, Nd:Yag lasers have been used to successfully cure early gastric cancer in selected patients.
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