Endoscopic Nd:YAG laser therapy for villous adenomas of the right colon.

Conio M, Caroli-Bosc F X, Filiberti R, Dumas R, Rouquier P, Demarquay J F, Aste H, Marchi S, Delmont J P

Department of Gastroenterology, National Institute for Cancer Research, National Institute for Cancer Research, Genoa, Italy.

Gastrointest Endosc. 1999 Apr;49(4 Pt 1):504-8. doi: 10.1016/s0016-5107(99)70051-9.

BACKGROUND

Endoscopic laser therapy is considered an acceptable treatment of benign colorectal adenomas. The aim of our study was to evaluate the efficacy of Nd:YAG laser to ablate right-sided colonic sessile adenomas.

METHODS

Between January 1990 and February 1996, 56 patients underwent laser therapy because of high operative risk or refusal of surgery. Lesions were located as follows: cecum (23), ascending, (15), and hepatic flexure (18). Six patients (10.7%) had multiple polyps in the ascending colon. Histologic examination showed a tubulovillous pattern in 20 (35.7%) and a villous pattern in 36 (64.3%). Low-grade dysplasia was detected in 44 patients (78. 5%) and high-grade dysplasia in 12 (21.4%).

RESULTS

The number of laser sessions ranged between 1 and 6 (median 3) and complete ablation, histologically confirmed, was achieved in 49 cases (87.5%). Seven patients (12.5%) underwent surgery: 2 for incomplete tumor destruction, 3 because of invasive carcinoma on repeated biopsies. Two patients (3.6%) had complications (one perforation of the cecum and one hemorrhage). Follow-up ranged from 6 to 60 months and no recurrences were observed.