Abstract
Background and Study Aims: Endoscopic resection of large colorectal adenomas is still not a standard procedure,
treatment with a high diathermic snare is considered as difficult and risky, and the
main disadvantage of laser vaporization is the unavailability of histological evaluation.
We studied a combined technique that enjoys the benefits of both techniques and avoids
the disadvantages and risks of each.
Patients and Methods: In a prospective study, we combined the techniques of high-frequency snare resection
as a preparatory method and Nd:YAG laser vaporisation as a second-stage treatment.
In 72 patients, we resected 79 adenomas, most of them in the rectum (81.0 %) and with
a tubulovillous histology (69.6 %), with a mean volume of 9.4 cm3 (1.5-29.0 cm3) and a base diameter ranging from 20 mm to 80 mm.
Results: After using the combined technique of preparatory mucosectomy as a first step and
laser vaporization as the second step, follow-up evaluation was possible in 50 out
of 72 patients (69.4 %). Fourteen patients had a local relapse of adenoma (28.0 %),
with dysplasia histologically of the same grade or a lower one compared to the original
grade, after a mean of 1.4 years. Since these local recurrences were diagnosed at
a size of a few millimeters (less than 3 mm), a further session of laser treatment
eliminated the material completely without complications. No colorectal carcinomas
were observed.
Conclusions: The high clinical long-term success of our combined electro-laser resection is not
only a result of complete endoscopic adenoma resection, but also of a strong control
regimen. This technique is applicable to the treatment of large colorectal adenomas
with curative intent.
