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Endoscopic neodymium yag laser for cardiac stricture of advanced gastric cancer

Endoscopic neodymium yag laser for cardiac stricture of advanced gastric cancer

Gastroenterological Endoscopy 30(9): 1925-1936

Thirty three patients suffering from dysphagia caused by the stricture of cardiac region were treated with the Nd:YAG laser (laser group). Eighty five percent of the patients showed the improvement of the stricture, and 67% of patients showed clinical improvement of taking food and was discharged from the hospital. In order to study the quantitative and qualitative result of laser-treated patients, we picked up two non-historical control groups. One was a non-curative resection (NCR) group which consisted of 16 patients, and the other was a chemotherapy group in which there were 12 patients treated only with immunochemotherapy. As to the survival times and the lengths of time in which patients required no hospitalization (no hospitalization period), there was no difference between the laser and the NCR groups. As to characteristics of the patients, no difference was seen by the Quantification method II between the patients in both the groups as to each factor of characteristics such as age, Borrmann's type, stage of TNM, chemotherapy, complication and metastasis. On the other hand, the median survival time was 43 weeks in the laser group and 15 weeks in the chemotherapy group (p < 0.001). In addition to that, the median value of no hospitalization period was 21 weeks in the former and only one week in the latter (p < 0.01). When the patient characteristics in these two groups were compared, there were proportionally more patients having categories of Borrmann's type 4, Tegafur as chemotherapy and no distant metastasis in the laser than in the chemotherapy group. Excluding the patients with those two to three categories, there was no difference as to each factor of the characteristics between the patients in the chemotherapy group and a modified group. The median survival time became 34 weeks in the modified laser group and 15 weeks in the chemotherapy group, revealing the statistical difference (p < 0.01). We conclude that Nd:YAG laser therapy is a useful palliative treatment for improving the stricture in cardiac region of gastric cancer. It could be said that the laser treatment should be applied as the first choice to a patient who is of proof risk or whom the surgical procedure is considered to end in a non-curative resection.

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Accession: 007300426

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