Villous tumors of the rectum. Endoscopic treatment using photocoagulation

We report the results of endoscopic photocoagulation in the treatment of villous adenomas of the rectum in 49 consecutive patients (26 males, and 23 females, mean age: 74 years). Twenty-six patients were treated with a high-power Nd-Yag laser (80 W/sec). After a mean of 3.4 laser sessions, all the small-sized adenomas (C1) and 88% of the intermediate-sized adenomas (C2) were healed. No extensive villous adenoma (C3) could be eradicated. Complications occurred in 5 patients. Recurrence was observed in 3 C2 patients who are still on maintenance laser therapy. Twenty-three patients were treated with another Nd-Yag laser (maximal power output: 45 W/sec). After a mean of 6.4 laser sessions, 85% of the C1 patients were healed, while eradication of villous tissues was obtained in 60% of C2 and C3 patients. No complications were noted. A recurrence was observed in three C1 patients with secondary healing after reinstitution of laser therapy in 2 cases. Moreover, two C3 patients also relapsed and laser eradication was again obtained in 1 patient. In conclusion, these results confirm the efficacy of laser therapy in small- and intermediate-sized villous adenomas of the rectum. The number of laser sessions required for eradicating a villous tumour was lower using a high-power Nd: Yag laser, but the risk of complications was increased.