Laser photocoagulation for upper gastrointestinal bleeding: the American experience.

Laser use in the United States for the treatment of gastrointestinal disease in general, and for upper GI bleeding in particular has grown exponentially. In 1979, only 3 American medical centers were using lasers for the therapy of UGI bleeding. Today, lasers are employed in more than 200 centers. Recently, the Food and Drug Administration, which regulates its use, has ruled that it is safe and effective, and therefore is no longer considered to be an investigational device. Most commonly it is used to treat discrete lesions such as ulcers, but it has been employed for other lesions, including varices. A recent American randomized controlled trial assessing its efficacy in acute esophageal variceal bleeding, found it to be effective for initial hemostasis; however, rebleeding was common. A key question is whether or not the laser is superior to other less costly and more portable modalities for treating acute UGI bleeding. One U.S. investigator recently presented data which suggested to him that the heater probe was better than the laser. There is insufficient comparative data available to answer the critical question about the relative superiority of one endoscopic treatment modality as compared to another. Foreseeable technologic advances may make laser therapy easier and more effective.