Endoscopic Nd-YAG Laser Research Articles

右主気管支閉塞に対してエタノール局注, 放射線照射, レーザー照射が有効であった肺扁平上皮癌の 1 例

右主気管支閉塞に対してエタノール局注, 放射線照射, レーザー照射が有効であった肺扁平上皮癌の 1 例

気道疾患における Nd-YAG レーザー治療の適応

気道疾患における Nd-YAG レーザー治療の適応

Endoscopic Nd-YAG laser surgery にて治癒せしめた気管支内過誤腫の 1 例

Endoscopic Nd-YAG laser surgery にて治癒せしめた気管支内過誤腫の 1 例

A Case of Endobronchial Hamartoma, Successfully Treated with Endoscopic Nd-YAG Laser and Electrosurgical Hot Biopsy Forceps Therapy

A Case of Endobronchial Hamartoma, Successfully Treated with Endoscopic Nd-YAG Laser and Electrosurgical Hot Biopsy Forceps Therapy

Endobronchial Endometriosis Nd-YAG Therapy vs Drug Therapy

I read with great interest the selected report by Puma et al 1 Puma F Carloni A Casucci G et al. Successful endoscopic Nd-YAG laser treatment of endobronchial endometriosis. Chest. 2003; : 1168-1170 Abstract Full Text Full Text PDF Scopus (28) Google Scholar in a recent issue of CHEST (September 2003). They described a case of endobronchial endometriosis that was successfully treated by Nd-YAG laser therapy. However, I would like to suggest that pulmonary endometriosis is probably less rare than is commonly thought, as I have counted 104 cases of tracheobronchial or pulmonary endometriosis as a result of searches of the medical literature (including 23 cases published in languages other than English). Some of these cases presented evidence such as a pattern of lung opacities or necropsy findings and not catamenial hemoptysis. I also think that Nd-YAG laser therapy could be useful for the treatment of endobronchial endometriosis only when drug therapy is not effective, or when the adverse effects of this drug therapy are intolerable, as this procedure is associated with a certain morbidity. Although the risk of general anesthesia is considered to be low, hypoxemia, hypercapnia, and acidosis secondary to apneas, and the reduction of ventilation are presumed to be the major causes of intraoperative and postoperative complications. 2 Vitacca M Natalini G Cavaliere S et al. Breathing pattern and arterial blood gases during Nd-YAG laser photoresection of endobronchial lesions under general anesthesia: use of negative pressure ventilation: a preliminary study. Chest. 1997; 112: 1466-1473 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar Cardiac arrest due to ventricular fibrillation may occur during rigid bronchoscopic laser therapy even in young patients with benign bronchial lesions. 3 D'Aloia A Faggiano P Fiorina C et al. Cardiac arrest due to ventricular fibrillation as a complication occurring during rigid bronchoscopic laser therapy. Monaldi Arch Chest Dis. 2003; 59: 88-90 Google Scholar The authors maintained that “Medical therapy has been recommended as the first choice in pulmonary endometriosis. It consists of the suppression of endometrial tissue with progesterone (ie, pseudopregnancy) or danazol (ie, pseudomenopause).” I only partly agree with this statement, as the authors failed to mention that gonadotropin-releasing hormone agonists have been prescribed for > 10 years and are effective in the treatment of this disease, as in our published case. 4 L'Huillier JP Salat-Baroux J Une observation d'endométriose pulmonaire. Rev Pneumol Clin. 2002; 58: 233-236 Google Scholar 5 Espaulella J Armengol J Bella F et al. Pulmonary endometriosis: conservative treatment with GnRH. Obstet Gynecol. 1991; 78: 535-537 PubMed Google Scholar Finally, I think that the follow-up period was not sufficiently long enough to ensure that the treatment was permanently effective. Unfortunately, the authors did not mention whether follow-up fiberoptic bronchoscopy was performed during menses.

Endoscopic laser ablation of advanced rectal carcinoma – a DGH experience

Patients with inoperable advanced rectal carcinoma require palliation for local symptoms. Endoscopic Nd-Yag laser ablation is a valid palliative treatment option in patients with advanced rectal carcinoma who are poor operative risks due to coexistent multiple comorbidities. All patients who cannot undergo radical surgery due to various factors such as tumour size, poor risk patients, distant metastasis and refusal to undergo surgery were offered palliation with endoscopic Nd-YAG laser ablation. Indications included troublesome bleeding, local recurrence, mucous discharge and impending obstruction. Patients were admitted on the day of treatment, phosphate enema given for bowel preparation and endoscopic ablation done through a flexible sigmoidoscope under intravenous sedation with midazolam. All patients were discharged the next day after overnight observation. Patients were reviewed every 3 months and laser ablation repeated if deemed necessary. Eleven patients (7 males, 4 females; mean age 83.6 years, range 77-90 years) underwent endoscopic laser ablation in a District General Hospital --8 for rectal carcinoma, 2 for rectosigmoid tumour and 1 for recurrent tubulovillous adenoma. The number of treatment episodes varied from 1 to 12 with symptom free interval from 2 to 18 months between treatment episodes. There were 3 failures, one patient required defunctioning colostomy, one patient was referred for radiotherapy due to persistent symptoms and in one patient laser treatment had to be abandoned due to local extent. There were no immediate post-treatment complications, but one patient developed incontinence after 5 episodes which might be attributable to tumour infiltration. Endoscopic laser ablation is a practical and feasible alternative to other palliative treatment modalities in the management of this unfortunate category of patients due to low morbidity and mortality, short hospitalization and low complication rates.

Successful Endoscopic Nd-YAG Laser Treatment of Endobronchial Endometriosis

Catamenial hemoptysis is a rare condition that is associated with the presence of intrapulmonary or endobronchial endometrial tissue. Diagnosis of and therapy for this condition are still a matter of debate. We describe a case of endobronchial endometriosis with catamenial hemoptysis. An endobronchial lesion was diagnosed by spiral CT scan, taken at the onset of the menses, and confirmed with flexible bronchoscopy. The patient was successfully treated with endoscopic Nd-YAG laser therapy with a 1-day in-hospital procedure. We suggest that endoscopic laser treatment should be the first line of therapy for central airway endometriosis, provided that the source of bleeding has been conclusively located and all of the lesions can be reached with the bronchoscope.

A Case of Endobronchial Tuberculosis with Cicatricial Stenoses Successfully Treated by Combination of Endoscopic Nd-YAG Laser and Balloon Dilatation Therapy

A Case of Endobronchial Tuberculosis with Cicatricial Stenoses Successfully Treated by Combination of Endoscopic Nd-YAG Laser and Balloon Dilatation Therapy

A Case of Endobronchial Hamartoma, Successfully Treated with Endoscopic Nd-YAG Laser and Low Wave-length KTP Laser Therapy

A Case of Endobronchial Hamartoma, Successfully Treated with Endoscopic Nd-YAG Laser and Low Wave-length KTP Laser Therapy

A Case of Postintubation Tracheal Stenosis Treated by Endoscopic Nd-YAG Laser and Balloon Catheter

The complications of endotracheal intubation are inevitable, of which postintubation tracheal stenosis may be required for surgical resection with primary reconstruction. Before surgery, several less invasive therapeutic modalites including bougie dilatation, stenting, and Nd-YAG laser incision are still available in use. Especially, good results were noted in selected patients with lengthy scars of less than 1cm and without tracheomalacia using endoscopic laser incision and dilatation. We report a case of a 54 yr-old woman with postintubation tracheal stenosis who was successfully treated by endoscopic Nd-YAG laser incision and esophageal balloon catheter.

Endoscopic treatment of early oesophageal or gastric cancer.

Endoscopic treatment has become increasingly popular in recent years as an alternative to surgical treatment with the hope of offering superior quality of life (QOL) for the patient. The results of endoscopic treatment of mucosal lesions of mostly early oesophageal or gastric cancer performed in 145 patients (155 lesions) over the past eight years were reviewed from the standpoint of QOL. In 56 patients who underwent radical resection of the oesophageal mucosa, no serious complications and symptoms occurred, with epithelialisation completed within about a month. Patients also showed good results regarding dietary intake and performance status (PS), and all are currently alive without any sign of recurrence. One time fractionated endoscopic resection was carried out in about 40% of the 57 patients who underwent gastric mucosal resection. In these 57 patients, an artificial ulcer measuring 3 cm or more was formed, resulting in a favourable outcome after healing. An overwhelming proportion of these subjects had no symptoms and good PS after the treatment. The introduction of this method, endoscopic mucosal resection using a cap fitted panendoscope, is expected to permit additional indications for endoscopic treatment. Endoscopic Nd-YAG laser irradiation was applied mainly to early gastric cancer lesions (32 patients), usually for relative indications for endoscopic treatment. This procedure is safe and advantageous in that it requires no hospitalisation, permits fractionated irradiation, and secures good QOL.

Nd-YAG レーザー焼灼術施行後切除した気管腺様嚢胞癌の 1 例

Nd-YAG レーザー焼灼術施行後切除した気管腺様嚢胞癌の 1 例

Endoscopic Nd-YAG laser therapy of gastric polyposis

Thirteen patients with gastric polyposis (113 polyps) were treated by endoscopic Nd-YAG laser irradiation. Among them there were five cases with adenomas, six with hyperplastic polyps and two with inflammatory polyps. Ninety-six polyps were <1 cm, 13 polyps were ⩾ 1 cm, and four polyps were ⩾ 2 cm. In the patient who had the largest number of lesions, 22 polyps were found at endoscopic examination. All but two patients were regularly followed up endoscopically for 2–5 years after treatment and showed no sign of recurrence. Mild bleeding occurred in three cases. No perforation or any other serious complications occurred. The results were encouraging. It is concluded that endoscopic Nd-YAG laser ablation of gastric polyposis is effective, simple to perform, safe and deserves recommendation.

ELEVEN CASES OF AIRWAY OBSTRUCTION DUE TO RECURRED ESOPHAGEAL CANCER TREATED WITH ND-YAG LASER

Eleven patients with tracheobronchial stenosis due to a recurrent malignant tumor following resection of an esophageal cancer were treated with neodymium-ytrrium-aluminium-garnet laser (Nd-YAG laser). Intermittent irradiation of Nd-YAG laser was done for 0.5 second at 20-30 Watt through a flexible bronchoscope under local anesthesia. After the recanalization of the airway, the laser therapy was repeated 2 to 16 times for every 14 to 21 days to avoid the recurrence of airway obstruction. The average survival time from the start of the laser therapy was 138 days and the median survival time was 83 days. The direct response for tumor size detected by CT-SCAN was not recognized but dyspnea of the patients was dramatically improved by the therapy. It is concluded that the endoscopic Nd-YAG laser therapy is useful in respiratory emergency for airway obstruction by recurrent malignant tumor after resection of esophageal cancer.

Successful treatment of two patients with gastric antral vascular ectasia ‘watermelon stomach’ using endoscopic Nd‐YAG laser therapy

Two patients with gastric antral vascular ectasia--'watermelon stomach'--successfully treated with endoscopic Nd-YAG laser are described. This condition is an uncommon cause of iron deficiency anaemia due to chronic blood loss and is usually managed by antrectomy. Endoscopic therapy with Nd-YAG laser offers an effective and safe alternative to surgery particularly in the elderly poor-risk patient.

Inoperable nonmetastatic squamous cell carcinoma of the esophagus managed by concomitant chemotherapy (5-fluorouracil and cisplatin) and radiation therapy

Thirty-five patients with nonmetastatic squamous cell carcinoma of the esophagus were treated with chemotherapy (5-fluorouracil, cisplatin) and concomitant split-course radiation therapy. All of the patients presented with dysphagia. Treatment consisted of two courses of chemotherapy with 5-FU (1 g/m2/day in continuous infusion for 5 days [days 1 to 5 and days 29 to 33] ) and cisplatin (70 mg/m2 intravenous bolus at days 2 and 30). Radiation therapy was concomitant in two courses delivering 20 Gy in 5 days (days 1 to 5 and days 29 to 33). On the first day of treatment, endoscopic peroral dilation or Nd-YAG laser therapy was usually carried out. At the end of the treatment, all of the patients were capable of oral nutrition. Histoendoscopic confirmation was made 8 weeks after the beginning of the therapy. Twenty-five of the 35 patients had a complete response with negative biopsy findings. There was only one serious complication (fatal myelosuppression) in the only patient who received more than two courses of chemotherapy. Sixteen patients died and 19 were still alive at 3 to 42 months after the beginning of treatment. Overall median survival for the 35 patients is 17 months. Actuarial survival was 55 +/- 18% at 1 year and 41 +/- 21% at 2 years. The median survival of the Stage I and II patients is 28 months. These results confirm that concomitant chemoradiotherapy is capable of producing a very high histoendoscopic complete response rate and improved 1-year and 2-year survival. The use of concentrated split-course radiotherapy enabled the authors to reduce the total length of the treatment to two periods of 5 days, with results that are similar to previous studies using classic radiotherapy for a 5-week to 7-week period.

Endoscopic Nd-YAG laser therapy as palliative treatment for esophageal and cardial cancer

The aim of this study was to report long-term results of endoscopic Nd-YAG laser therapy in the palliative treatment of 144 esophageal and cardial carcinomas and to define parameters that could predict the long-term outcome in order to better define the indications and limitations of Nd-YAG laser therapy for esophagocardial cancer. One hundred nineteen men and 25 women were treated. The mean age was 67 +/- 12 years. Histology showed 94 patients with squamous cell carcinoma and 50 with cardial or esophageal adenocarcinoma. Improvement of dysphagia was achieved in 119 of the 144 patients (83%) after a median of 2.9 sessions. For the 105 patients initially symptomatically improved by the first laser course, the cumulative probability of remaining symptomatically improved at three and six months was respectively 38.5 +/- 5% and 22 +/- 4%. Four perforations and nine esophagotracheal fistulas occurred. In the stepwise regression analysis (Cox model), among 11 variables, three variables had an independent prognostic value at six months. The importance of improvement after the initial laser treatment (P less than 0.005) and the presence of an adenocarcinoma (P less than 0.05) were positively correlated with the symptom improvement duration. The initial tumor length (P less than 0.01) was negatively correlated with the symptomatic improvement duration. Therefore, in inoperable patients, we think that laser therapy should be proposed first for adenocarcinoma and for squamous cell carcinoma less than 6 cm in length.(ABSTRACT TRUNCATED AT 250 WORDS)

早期胃癌に対するNd-YAG laser内視鏡治療の実態と将来像

Since middle of 1970s, endoscopic laser treatment had been applied hemostasis in the upper GI tract. At the beginning of 1980s, Nd-YAG laser endoscopy was applyed clinically for the treatment of the GI tumors.Since 1979, we have been studying experimentally and clinically for the possible application of the endoscopic Nd-YAG laser treatment for early gastric cancers. Noncantact laser irradiation had been performed until 1983. From 1984, we have been developing the Nd-YAG laser contact method with several contact probes and computer-controlled Nd-YAG laser hyperthermia (taserthermia) system in cooperation with Sri Japan Co. Nd-YAG laser contact method with various kinds of contact probes could treat every type of lesions as endoscopic photocoagulation, vaporization, mucosal cutting, Laserthermia. Actually clinical effects by contact method had been risen about 15-25% higher then those by the conventional noncontact method.However, it was difficult treating all of the cases concering early gastcic cancers by laser endoscopic alone.Therefor many patterns of the combination therapy of the contact laser method and the other endoscopic therapeutics and general treatments should be nacessary.

腫ようによる気管狭窄

Since 1980, we began applying fiberoptic bronchoscopic Nd-YAG laser treatment fortracheal-carinal tumors. Endoscopic Nd-YAG laser treatment and adjuvant therapy wereperformed in 16 cases of primary tracheal tumor (12 malignant lesions and 4 benign lesions) and 39 cases of metastatic tracheal lesions. For 28 cases presenting severe respiratory distress, the procedure was performed as an emergency life-saving procedure and dramatic improve-ment in condition was seen in 26 cases (92. 9%) . Twenty seven cases were treated by stagedlaser reduction of the residual airway lesion. Effectiveness was observed in 24 cases (88. 9%) . In these cases, after Nd-YAG laser treatment for ventilatory improvement, local or systemicadjuvant therapy was performed. Local adjuvant therapy was performed in 29 cases, 11 caseswere treated surgically (4 tracheoplasties and 10 treacheal tube stent operations) and 28 casesunderwent radiotherapy.In addition to these cases, there were 5 cases who underwent tracheal resection withoutpreoperative Nd-YAG laser treatment. These 5 cases consisted of 3 tracheal tumors and 3metastatic lesions from the thyroid gland.Bronchoscopic Nd-YAG laser treatment is a relatively new method for the treatment oftracheal or carinal tumor with ventilatory disturbance due to airway stenosis.

急性気道閉塞をきたした気管, 気管支腫瘍に対するNd-YAGレーザー治療の経験

The results of endoscopic Nd-YAG laser trestment in 9 obstructive tracheobranchial tumor are reported. There were 4 primary lung cancers, 3 metastatic air way lesions, primary lesions consisted of lung cancer, ovarial cancer and osteosarcoma, and 2 invasive esophageal cancers. Satisfactory results (more than 50% reduction in size of intraluminal tumor and immediate relief of dyspnear) were obtained in 6 cases, and effective results (less than 50% reduction in size of intraluminal tumor and immediate relief of dyspnear) were obtained in 2 cases. Only one case was not effective result (no relief of dyspear) who had already cerebral metastasis of esophageal cancer.