Palliation of oesophageal cancer--endoscopic intubation and laser therapy.

Oesophageal carcinoma, accounting for approximately 10 deaths per 100,000 people annually, is a major health problem in the United Kingdom.' With many patients presenting with disseminated disease, either manifest or occult, curative treatment is applicable to only a small minority. For the majority of patients palliative relief of dysphagia is the goal of treatment. Clinicians have an ever increasing armamentarium of palliative techniques to choose from but no single treatment modality has emerged as clearly superior to all others. The ideal palliative therapy would restore normal deglutition while avoiding prolonged hospitalization, repetitive treatments, and significant morbidity and mortality. Palliative treatment options include surgical resection, surgical bypass, radiotherapy, brachytherapy, dilatation, intubation, laser therapy, electrocoagulation, and chemoradiotherapy.'-4 Although many consider surgical resection to be the palliative procedure of choice for carcinoma of the oesophagus,`7 a large group of patients are unsuitable for resection because of advanced disease or poor general health.8 The correct identification of patients that are best served by alternative treatment modalities requires the utmost in surgical judgement.9 Until recently many of these patients have been treated with endoscopic intubation, with or without radiotherapy. NdYAG (neodymium yttrium aluminium garnet) laser therapy now offers another therapeutic option that at first glance is competitive with intubation. This article will review the place of both therapies in the palliative treatment of oesophageal carcinoma. Intubation