The association of endoscopic resection with
Nd:YAG laser photocoagulation was used to treat benign colorectal
villous adenomas. Eight-five patients were included: 49 with surgical
contraindications, 35 for whom surgical resection appeared to be too hazardous, and 1 who refused surgery. Forty-five
tumors had an axial extension between 1 and 3 cm, and 40
tumors had an axial extension of at least 4 cm. Diathermic snare resection was performed to remove large tumoral fragments prior to
laser photocoagulation of the residual flat lesions. Treatments were repeated every 15 days until total
tumor destruction was achieved. A
carcinoma was detected in biopsy specimens obtained during endoscopic treatment of five patients. Two patients were lost to follow-up. Treatment results could be analyzed in 78 patients. Successful treatment was achieved in 67 patients.
Tumor destruction was complete in 77 percent of patients who had lesions of at least 4 cm diameter and in 93 percent of patients with smaller lesions. The axial extension of the
tumor was the main factor affecting the results of treatment. No major complications occurred. During the average 103-week follow-up period, 21 percent of the patients with total
tumor destruction had a recurrence. The risk of recurrence was correlated with the number of initial treatment sessions and previous surgery treatment. It would appear that the treatment with endoscopic resection prior to
Nd:YAG laser photocoagulation is a safe and effective method in the destruction of colorectal
villous adenomas.