Endoscopic Resection of Large Colorectal Adenomas: A Combination of Snare and Laser Ablation

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.