Laser Therapy

Endoscopic laser treatment usually with Nd:YAG is best suited in debulking short, noncircumferential lesions in the mid- to distal esophagus. The laser probe is introduced through the endoscopic channel and treatment begun in a caudal to rostral direction. The effective depth of destruction can be as much as 4 to 6 mm. The procedure may be performed in several sessions for long or bulky tumors. Treatment response is usually related to tumor length, circular extend, and relationship to the esophageal sphinc ters. Short segments in the distal esophagus are easier to treat. Laser treatment of proximal segments may be better tolerated and easier with general anesthesia. Laser treatment can restore luminal patency in up to 90% of patients, with improvement in dysphagia in 70 to 85% of cases. For longer and severe circumferential cancer, relief of dysphagia is usually short-lived and repeat sessions are required. Complications include all those associated with thermal therapies, including transient dysphagia, chest pain, pleural effusions, fever, and perforation (1 to 15%). The major disadvantages of this modality include the high equipment costs, difficulty in using the laser in angulated areas (cricopharyngeus and lower esophagus), and the not uncommon requirement for several sessions before desired results are achieved. Types of lasers available for endoscopic usage include Nd:YAG and diode lasers. Nd:YAG coagulates vessels and tissues at lower power and vaporizes tissues at high power. Although palliation of dysphagia is now mainly performed with endoscopic prostheses, for asymmetrical or noncircumferential lesions, thermal debulking is still appreciated. Some studies have revealed a prolonged dysphagia improvement period by debulking with Nd:YAG laser followed by external bean radiation and intraluminal brachytherapy.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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