Endoscopic resection of large colorectal adenomas: A combination of snare and laser ablation

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 cm(3) (1.5-29.0 cm(3)) 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.