Endoscopic Nd:YAG laser therapy for villous adenomas of the colon and rectum

We reviewed 34 villous tumors of the colon and rectum treated endoscopically with neodymium:YAG laser therapy from 1983 to the present. Twenty-three tumors were benign, and 11 contained carcinoma in situ. Invasive carcinomas were excluded. Treatment locations included cecum (6), descending colon (1), sigmoid colon (2), and rectum (25). Fourteen males and 20 females with a mean age of 70 years (31-93) completed an average of 3.3 total treatments per patient under no sedation (9), intravenous demerol (24), or general anesthesia (1). Treated tumors ranged between 2-12 cm in greatest dimension, and one fourth were 50 to 100 per cent circumferential. Four patients presented with recurrent tumors subsequent to transanal excisions, done elsewhere. Five patients suffered complications of mild stricture (2), self-limited bleeding (2), and one pinhole colovaginal fistula. There was one incomplete treatment and one recurrence in the cecum that was carcinoma in situ at resection. There were no missed cancers during follow up that ranged from 1-120 months (average 32 months). The average total cost for the entire treatment per patient was $3627. Endoscopic neodymium:YAG laser therapy of villous tumors of the colon and rectum is a safe and effective outpatient procedure. The complication rate is lower than most reported series of operatively treated patients, and sphincter dysfunction, incontinence, or fecal fistula is avoided. With close follow up and repeated biopsy, invasive carcinoma can be ruled out. We believe this is the procedure of choice for management of these tumors.