ENDOSCOPIC PALLIATION OF COLORECTAL-CANCER

Palliating colorectal cancer by endoscopy means palliating rectosigmoidal cancer. Surgical palliation is preferred in tumour stenosis located higher than the first third of the sigma or distal rectum with infiltration of the anal and perianal region. indications for endoscopic palliation are limited to incurable rectosigmoid tumours with multiple metastases, for general inoperability or in recurrent anastomotic cancers. There are several methods currently available for local palliative therapy. Cryotherapy is obsolete because of the acute and late bleeding risks from the base of the tumour. Electrocoagualtion is feasible, however, time-consuming using the monopolar method. If the tumour is highly stenotic, auxiliary techniques consisting of prelaser bouginage or balloon dilation are useful. Combination therapies with intraluminal high dose irradiation or metal stents seem to be promising, according to a few case reports. At the present time, endoscopic laser therapy is the most established palliative treatment for colorectal cancers. Standard is the solid state neodymium:YAG laser. Contact laser therapy with sapphire tips or bare fibre has the advantage that no gas insufflation is required. This makes the procedure more comfortable for the patient. On the other hand, these techniques are more time-consuming than the noncontact laser irradiation. Laser therapy can be performed as an out-patient procedure. The success rate of more than 90% can be achieved with a very low complication rate of about 5%.