Laser photoablation of colorectal adenomas: a 12-year experience.

ABSTRACT

BACKGROUND: We analyze laser photoablation as an alternative treatment of large sessile polyps in inoperable patients. METHODS: Ninety-four colorectal polyps (mean diameter 3.09 +/- 2.7 cm, range 1-15 cm) were treated using high-energy lasers (NdYAG and diode). Grade of dysplasia was low in 51, high in 35, with focally invasive cancer in eight. RESULTS: After 405 laser sessions (4.3 per polyp) five procedure-related complications were observed two strictures, two bleedings, and one perforation. The last needed a surgical resection; the others were successfully treated by endoscopic therapy. Fifty-seven polyps (61%) were completely eradicated and the growth was controlled in all but two (98%). No degeneration was found after 28-month follow-up of treated adenomas with low- or high-grade dysplasia. Outcome of treatment was dependent on the dimension and grade of the dysplasia (p < 0.05), but not on the polyps' position (rectum or colon). Relief of rectal bleeding was obtained in 90%, of mucus discharge in 77%, and of tenesmus in 100% of cases. CONCLUSIONS: Laser photoablation of colonic adenomas can be considered a valid procedure not only to relieve symptoms, but also to control the risk of degeneration in patients unfit for surgery or when surgical treatment is considered excessively invalidating.