ENDOSCOPIC TREATMENT OF SESSILE RECTAL ADENOMAS - COMPARISON OF ND-YAG LASER THERAPY AND INJECTION-ASSISTED PIECEMEAL POLYPECTOMY

This prospective study was carried out in order to compare endoscopic laser therapy with injection-assisted piecemeal polypectomy for treatm ent of sessile rectal adenomas. We randomized 94 patients with rectal sessile adenomas to either of the two treatments. The adenomas were cl assified according to size as extensive or intermediate. Of the patien ts with extensive adenomas, a complete ablation was achieved in 63.6% with laser versus 33.3% with piecemeal snaring (p < .01). For the inte rmediate adenomas, the rates of permanent ablation were 81.2% with las er versus 86.6% with piecemeal snaring polypectomy (difference not sta tistically significant). The complication rates were acceptable in bot h the laser and piecemeal snaring groups. (One case of perforation and one case of stenosis were observed in the laser group, both probably related to prior electroresection.) Our study suggests that the specif ic indication for laser therapy should be extensive lesions; with inte rmediate adenomas, laser therapy and injection-assisted piecemeal poly pectomy are equally efficacious for achieving complete ablation. Howev er, the duration of initial treatment differs: 6.3 weeks for laser the rapy versus 2.4 weeks for piecemeal polypectomy; moreover, about 70% o f the intermediate adenomas were eradicated with a single session of p iecemeal polypectomy.