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

Background: Endoscopic laser therapy is considered an acceptable treatment of benign colorectal adenomas. The aim of our study was to evaluate the eff icacy of Nd:YAG laser to ablate right-sided colonic sessile adenomas. Methods: Between January 1990 and February 1996, 56 patients underwent lase r therapy because of high operative risk or refusal of surgery. Lesions wer e located as follows: cecum (23), ascending, (15), and hepatic flexure (18) . Six patients (10.7%) had multiple polyps in the ascending colon. Histolog ic examination showed a tubulovillous pattern in 20 (35.7%) and a villous p attern 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 destr uction, 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. Conclusion: Laser therapy is an effective method for the destruction of ses sile adenomas of the right colon in selected patients.