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 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.