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Use of the Nd:YAG laser in therapeutic endoscopy has caught the imagination of many physicians. Understanding the principles of laser physics to apply laser techniques correctly is not difficult. Currently, the laser is used for control of gastrointestinal hemorrhage and for debulking obstructing tumors in the upper and lower gastrointestinal tract. Hemostasis has been achieved in 70–100% of patients with a variety of bleeding lesions. Specific laser techniques vary in the power used and exposure time, but some standardization has been agreed on. Obstructing gastrointestinal neoplasms may now be safely and effectively ablated to achieve patency of the lumen. Perforation from laser therapy occurs in 1% or less of patients treated, making this a reasonably safe form of treatment. The high cost of laser unit (approximately $85,000) and the availability of equally effective and more reasonably priced alternatives require careful attention to the cost-effectiveness of the laser. Training physicians in the safe use of lasers is a problem that still must be solved by the users and instrument makers.