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

被引:17
作者
DEPALMA, GD [1 ]
CAIAZZO, C [1 ]
DIMATTEO, E [1 ]
CAPALBO, G [1 ]
CATANZANO, C [1 ]
机构
[1] UNIV NAPLES FEDERICO II,SERV CENTRALIZZATO ENDOSCOPIA DIGEST OPERATORIA,NAPLES,ITALY
关键词
D O I
10.1016/S0016-5107(95)70189-3
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
This prospective study was carried out in order to compare endoscopic laser therapy with injection-assisted piecemeal polypectomy for treatment of sessile rectal adenomas. We randomized 94 patients with rectal sessile adenomas to either of the two treatments. The adenomas were classified according to size as extensive or intermediate. Of the patients with extensive adenomas, a complete ablation was achieved in 63.6% with laser versus 33.3% with piecemeal snaring (p < .01). For the intermediate adenomas, the rates of permanent ablation were 81.2% with laser versus 86.6% with piecemeal snaring polypectomy (difference not statistically significant). The complication rates were acceptable in both 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 specific indication for laser therapy should be extensive lesions; with intermediate adenomas, laser therapy and injection-assisted piecemeal polypectomy are equally efficacious for achieving complete ablation. However, the duration of initial treatment differs: 6.3 weeks for laser therapy versus 2.4 weeks for piecemeal polypectomy; moreover, about 70% of the intermediate adenomas were eradicated with a single session of piecemeal polypectomy.
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页码:553 / 556
页数:4
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共 16 条
[1]  
Thompson JP., Treatment of sessile and tubulovillous adenomas of the rectum: experience of St. Mark's Hospital, Diseases of the Colon & Rectum, 20, pp. 467-472, (1977)
[2]  
Malafosse M, Roge P., Surgical management of villous tumors of the colon and rectum, Digestive Surgery, 1, pp. 168-171, (1984)
[3]  
Chiu YS, Spencer RI., Villous lesions of the colon, Dis Colon Rectum, 21, pp. 493-495, (1978)
[4]  
Delile P, Marche C, Edelman G, Les tumeurs villeuses du colon et du rectum. Problmes diagnostiques et thérapeutiques, Ann Chir, 31, pp. 829-842, (1977)
[5]  
Buess G, Huherer F, Theiss J, Pichlmaier H, Das system für die transanale endoskopiche rectumoperationem, Chirurg, 55, pp. 677-680, (1984)
[6]  
Buess G, Kipmueller K, Hack D., Clinical results of transanal endoscopic microsurgery, Surg Endosc, 2, pp. 245-250, (1988)
[7]  
Brunetaud JM, Maunoury V, Cocheland D., Endoscopic laser treatment for rectosigmoid villous adenoma: factors affecting the results, Gastroenterology, 97, pp. 272-277, (1989)
[8]  
Lambert R, Larsen G, Guyot P., Villous adenoma in the rectum: follow-up after laser therapy, Gastrointest Endosc, 31, pp. 147-148, (1985)
[9]  
Mathus-Vliegen EMH, Tytgat GNJ., The potential and limitation of laser photoablation of colorectal adenomas, Gastrointest Endosc, 37, pp. 9-17, (1991)
[10]  
Brunetaud JM, Mosquet L, Hauch M., Villous adenomas of the rectum. Results of endoscopic treatment with argon and Nd-YAG laser, Gastroenterology, 89, pp. 832-837, (1985)