Fifteen patients with advanced adenocarcinoma of the gastric cardia were treated with endoscopic neodymium:yttrium aluminum garnet laser therapy. Four patients developed recurrence after previous surgery. In 7 patients, a decision was made at exploration that a palliative operation was not feasible. In the remaining 4 patients, surgery was not considered because of widespread disease or the patient's condition. Fourteen of fifteen were classified as stage IV (tumor, node, metastasis). Tumors ranged in length from 3 to 10 cm (mean 6.3). Luminal opening was 4 mm or less in 12 patients. The mean number of treatments required to alleviate symptoms and remove obstruction was 2.8 (range 1-5) and the mean number of days required was 5.7 (range 1-12). An average of 6129 W/s were given per treatment and the mean total energy was 17,570 W/s. Luminal diameter at the narrowest segment increased from 3.3 mm before treatment to 12.1 mm after treatment. Clinical benefit in terms of increased food intake was demonstrated in all patients. No major complications directly attributable to laser therapy were seen. The overall results are encouraging and hold promise for a patient population in whom the therapeutic options are generally very limited.