We prospectively studied the short-term and long-term efficacy and safety of endoscopic laser treatment in 25 patients with dysphagia from advanced esophageal cancer. Malignant stenoses were recanalized in all patients, and the ability to swallow was improved in about 80%. Results were best in patients with adenocarcinomas and in those who reported a good appetite. A single laser treatment provided adequate palliation in more than half the patients until the time of death. In those patients in whom stenosis recurred, re-treatment was necessary a median of 3.2 months after the initial laser treatment. No laser-related mortality or major morbidity occurred. We conclude that endoscopic laser therapy seems to be a feasible method of palliating malignant dysphagia.