Sir
We read with interest the paper by Dr Shmueli and colleagues ( B r J Sury 1992; 79: 778-80) on their experience with laser palliation of malignant dysphagia. Since 1989, we have treated 85 patients with 307 neodymium yttrium-aluminium-garnet laser treatments for malignant dysphagia. Almost all procedures were performed on an outpatient basis. There were no deaths associated with the treatment. No patient required insertion of an endoprosthesis; two suffered perforations, both of which were treated conservatively. Of the 85 patients, a further 38 received, in addition to the laser therapy, endoluminal radiation therapy plus external beam radiotherapy and chemotherapy. Patients who received both treatments required fewer ( P < 0.001 ) laser treatments than those who did not receive chemoradiation treatment. There were no treatment-reiated deaths.
Given these results. we are concerned at the 12 per cent complication rate, 4 per cent mortality rate, 21 per cent laser failure rate and 11 per cent intubation rate with its 9 per cent mortality rate reported by Shmueli et a/. We feel that, from our experience, different conclusions regarding the value of laser (and particularly laser plus radiation) therapy in the management of malignant dysphagia can bc made.