A new palliative treatment technique for esophageal carcinoma using endoscopic neodymium:yttrium aluminum garnet (Nd:YAG) laser therapy is described in 14 patients for whom no curative therapy is possible. Tumors ranged in length from 5 to 11 cm (mean 8.2 cm) and in 11 patients luminal occlusion before treatment was greater than 90%. The mean number of treatments required to alleviate symptoms and remove obstruction was 5.3 (range 2-13) and the mean number of days required was 11.6 (range 5-28). An average of 4615 W-s were given per treatment and the mean total energy per patient was 24,394 W-s. In all 14 patients, clinical, endoscopic, and radiographic improvement was noted. Two major complications occurred which may possibly have been caused by laser therapy. The overall results are encouraging and hold promise for a patient population in whom the therapeutic options are generally very limited.