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Colorectal Neodymium-YAG Photoablative Therapy: Comparing Applications and Complications on Both Sides of the Peritoneal Reflection

Colorectal Neodymium-YAG Photoablative Therapy: Comparing Applications and Complications on Both... Abstract • Laser photoablative therapy has seen wide application in the esophagus, stomach, and rectum. Its use in the supraperitoneal colon has been less extensive because of fear of complications. One hundred fifteen patients who presented during a four-year period and underwent neodymium-YAG laser treatment on both sides of the peritoneal reflection (rectum, 47 patients; colon, 68 patients) were reviewed. The various lesions treated with laser therapy included 32 malignant tumors that presented with bleeding or obstruction, 44 large broad-based villous adenomas, six carcinoid tumors, and 33 patients with arteriovenous malformations or radiation proctitis who presented with acute hemorrhage or chronic blood loss. Overall treatment efficiency was 83% in the rectal group vs 87% in the colonic group. There was no significant difference in complication frequency or severity between the two groups, even though 45% of the colonic lesions were located in the thin-walled cecum. There was no laser-related mortality in this series. Laser photoablative therapy is safe and effective treatment for a wide variety of colorectal lesions. In experienced hands, it can be used on either side of the peritoneal reflection with equal efficiency and no increased risk of complications. (Arch Surg 1989;124:684-688) References 1. Fleischer D, Kessler F, Haye O: Endoscopic Nd:YAG laser therapy for carcinoma of the esophagus: A new palliative approach . Am J Surg 1982; 143:280-283.Crossref 2. Pietrafitta JJ, Dwyer RM: Endoscopic laser therapy of malignant esophageal obstruction . Arch Surg 1986;121:395-400.Crossref 3. Murray FE, Bowers GJ, Birkett DH, et al: Palliative laser therapy of advanced esophageal carcinoma: An alternative perspective . Am J Gastroenterol 1988;83:816-819. 4. Fleischer D, Sivak MV: Endoscopic Nd:YAG laser therapy as palliative treatment for advanced adenocarcinoma of the gastric cardia . Gastroenterology 1984;87:815-820. 5. Souquet JC, Sabben G, Chavaillon A, et al: Traitement laser des tumeurs villeuses rectales . Ann Gastroenterol Hepatol 1987;23:311-314. 6. Lambert R, Sabben G, Guyot P, et al: Villous adenoma in the rectum: Follow-up after laser therapy . Gastrointest Endosc 1985;31:147. 7. Kiefhaber P, Kiefhaber K, Huber F: Preoperative neodymium-YAG laser treatment of obstructive colon cancer . Endoscopy 1986;18:44-46.Crossref 8. Mathus-Vliegen EMH, Tytgat GNJ: Laser ablation and palliation in colorectal malignancy: Results of a multicenter inquiry . Gastrointest Endosc 1986;32:393-396.Crossref 9. Russin DJ, Kaplan SR, Goldberg RI, et al: Neodymium-YAG laser: A new palliative tool in the treatment of colorectal cancer . Arch Surg 1986;121:1399-1403.Crossref 10. Rutgeerts P, Vantrappen G, Broeckaert L, et al: Controlled trial of YAG laser treatment of upper digestive hemorrhage . Gastroenterology 1982;83:410-416. 11. Bown SG, Swain CP, Storey DW, et al: Endoscopic laser treatment of vascular anomalies of the upper gastrointestinal tract . Gut 1985;26:1338-1348.Crossref 12. Rutgeerts P, Van Gompel F, Geboes K, et al: Long term results of treatment of vascular malformations of the gastrointestinal tract by neodymium YAG laser photocoagulation . Gut 1985;26:586-593.Crossref 13. Brunetaud JM, Mosquet L, Houcke M, et al: Villous adenomas of the rectum: Results of endoscopic treatment with argon and Nd:YAG lasers . Gastroenterology 1985;89:832-837. 14. Brunetaud JM, Maunoury V, Ducrotte P, et al: Palliative treatment of rectosigmoid carcinoma by laser endoscopic photoablation . Gastroenterology 1987;92:663-668. 15. Escourrou J, Delvaux M, Frexinos J, et al: Treatment of rectal cancer with the neodymium-YAG laser . Gastroenterol Clin Biol 1986;10:152-157. 16. Kuvshinov IP, Poddubnyi BK, Veselov VV, et al: Immediate results of the treatment of cancer patients . Vopr Onkol 1986;32:58-60. 17. Goligher J: Surgery of the Anus, Rectum, and Colon , ed 5. London, Bailliere Tindall, 1984, pp 741-743. 18. Phillips RKS, Hittinger R, Fry JS, et al: Malignant large bowel obstruction . Br J Surg 1985;72:296-302.Crossref 19. Naveau S, Roulot D, Zourabichvili O, et al: Tratement palliatif des adenocarcinomes du rectum par le laser YAG neodyme: Resultats immediats et a long terme: Etude des facteurs lies a la destruction tumorale initiale . Gastroenterol Clin Biol 1986;10:651-655. 20. Bown SG, Barr H, Matthewson K, et al: Endoscopic treatment of inoperable colorectal cancers with the Nd YAG laser . Br J Surg 1986;73:949-952.Crossref 21. Madden JL, Kandalaft SI: Electrocoagulation as a primary curative method in the treatment of carcinoma of the rectum . Surg Gynecol Obstet 1983;157:164-179. 22. Mlasowsky B, Duben W, Jung D: Cryosurgery for palliation of rectal tumours . J Exp Clin Cancer Res 1985;4:81-83. 23. Osborne DR, Higgins AF, Hobbs KEF: Cryosurgery in the management of rectal tumours . Br J Surg 1978;65:859-861.Crossref 24. Papilon J: New prospects in the conservative treatment of rectal cancer . Dis Colon Rectum 1984;27:695-700.Crossref 25. Sischy B: The place of radiotherapy in the management of rectal adenocarcinoma . Cancer 1982;50:2631-2637. 26. Puthawala AA, Syded AMN, Gates TC, et al: Definitive treatment of extensive anorectal carcinoma by external and interstitial irradiation . Cancer 1982;50:1746-1750.Crossref 27. Kellokumpu I, Husa A: Colorectal adenomas: Morphologic features and the risk of developing metachronous adenomas and carcinomas in the colorectum . Scand J Gastroenterol 1987;22:833-841.Crossref 28. Christenson CE, Nemer FD, Schottler JL, et al: Villous adenomas of the rectum: The accuracy of clinical assessment . Acta Med Scand 1981;210:187-192. 29. Stulc JP, Petrelli NJ, Herrera L, et al: Colorectal villous and tubulovillous adenomas equal to or greater than four centimeters . Ann Surg 1987;207:65-71.Crossref 30. Nivatvongs S, Nicholson JD, Rothenberger DA, et al: Villous adenomas of the rectum: The accuracy of clinical assessment . Surgery 1980;87:549-551. 31. Boley SJ, Sammartano R, Brandt LJ, et al: Vascular ectasias of the colon . Surg Gynecol Obstet 1979;149:353-359. 32. Mathus-Vliegen EM, Tytgat GN: ND:YAG laser photocoagulation in colorectal adenoma: Evaluation of its safety, usefulness, and efficacy . Gastroenterology 1986;90:1865-1873. 33. Mathus-Vliegen EMH: Complications and pitfalls of laser therapy . Endoscopy 1986;18:69-72.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Colorectal Neodymium-YAG Photoablative Therapy: Comparing Applications and Complications on Both Sides of the Peritoneal Reflection

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References (35)

Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1989.01410060046010
Publisher site
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Abstract

Abstract • Laser photoablative therapy has seen wide application in the esophagus, stomach, and rectum. Its use in the supraperitoneal colon has been less extensive because of fear of complications. One hundred fifteen patients who presented during a four-year period and underwent neodymium-YAG laser treatment on both sides of the peritoneal reflection (rectum, 47 patients; colon, 68 patients) were reviewed. The various lesions treated with laser therapy included 32 malignant tumors that presented with bleeding or obstruction, 44 large broad-based villous adenomas, six carcinoid tumors, and 33 patients with arteriovenous malformations or radiation proctitis who presented with acute hemorrhage or chronic blood loss. Overall treatment efficiency was 83% in the rectal group vs 87% in the colonic group. There was no significant difference in complication frequency or severity between the two groups, even though 45% of the colonic lesions were located in the thin-walled cecum. There was no laser-related mortality in this series. Laser photoablative therapy is safe and effective treatment for a wide variety of colorectal lesions. In experienced hands, it can be used on either side of the peritoneal reflection with equal efficiency and no increased risk of complications. (Arch Surg 1989;124:684-688) References 1. Fleischer D, Kessler F, Haye O: Endoscopic Nd:YAG laser therapy for carcinoma of the esophagus: A new palliative approach . Am J Surg 1982; 143:280-283.Crossref 2. Pietrafitta JJ, Dwyer RM: Endoscopic laser therapy of malignant esophageal obstruction . Arch Surg 1986;121:395-400.Crossref 3. Murray FE, Bowers GJ, Birkett DH, et al: Palliative laser therapy of advanced esophageal carcinoma: An alternative perspective . Am J Gastroenterol 1988;83:816-819. 4. Fleischer D, Sivak MV: Endoscopic Nd:YAG laser therapy as palliative treatment for advanced adenocarcinoma of the gastric cardia . Gastroenterology 1984;87:815-820. 5. Souquet JC, Sabben G, Chavaillon A, et al: Traitement laser des tumeurs villeuses rectales . Ann Gastroenterol Hepatol 1987;23:311-314. 6. Lambert R, Sabben G, Guyot P, et al: Villous adenoma in the rectum: Follow-up after laser therapy . Gastrointest Endosc 1985;31:147. 7. Kiefhaber P, Kiefhaber K, Huber F: Preoperative neodymium-YAG laser treatment of obstructive colon cancer . Endoscopy 1986;18:44-46.Crossref 8. Mathus-Vliegen EMH, Tytgat GNJ: Laser ablation and palliation in colorectal malignancy: Results of a multicenter inquiry . Gastrointest Endosc 1986;32:393-396.Crossref 9. Russin DJ, Kaplan SR, Goldberg RI, et al: Neodymium-YAG laser: A new palliative tool in the treatment of colorectal cancer . Arch Surg 1986;121:1399-1403.Crossref 10. Rutgeerts P, Vantrappen G, Broeckaert L, et al: Controlled trial of YAG laser treatment of upper digestive hemorrhage . Gastroenterology 1982;83:410-416. 11. Bown SG, Swain CP, Storey DW, et al: Endoscopic laser treatment of vascular anomalies of the upper gastrointestinal tract . Gut 1985;26:1338-1348.Crossref 12. Rutgeerts P, Van Gompel F, Geboes K, et al: Long term results of treatment of vascular malformations of the gastrointestinal tract by neodymium YAG laser photocoagulation . Gut 1985;26:586-593.Crossref 13. Brunetaud JM, Mosquet L, Houcke M, et al: Villous adenomas of the rectum: Results of endoscopic treatment with argon and Nd:YAG lasers . Gastroenterology 1985;89:832-837. 14. Brunetaud JM, Maunoury V, Ducrotte P, et al: Palliative treatment of rectosigmoid carcinoma by laser endoscopic photoablation . Gastroenterology 1987;92:663-668. 15. Escourrou J, Delvaux M, Frexinos J, et al: Treatment of rectal cancer with the neodymium-YAG laser . Gastroenterol Clin Biol 1986;10:152-157. 16. Kuvshinov IP, Poddubnyi BK, Veselov VV, et al: Immediate results of the treatment of cancer patients . Vopr Onkol 1986;32:58-60. 17. Goligher J: Surgery of the Anus, Rectum, and Colon , ed 5. London, Bailliere Tindall, 1984, pp 741-743. 18. Phillips RKS, Hittinger R, Fry JS, et al: Malignant large bowel obstruction . Br J Surg 1985;72:296-302.Crossref 19. Naveau S, Roulot D, Zourabichvili O, et al: Tratement palliatif des adenocarcinomes du rectum par le laser YAG neodyme: Resultats immediats et a long terme: Etude des facteurs lies a la destruction tumorale initiale . Gastroenterol Clin Biol 1986;10:651-655. 20. Bown SG, Barr H, Matthewson K, et al: Endoscopic treatment of inoperable colorectal cancers with the Nd YAG laser . Br J Surg 1986;73:949-952.Crossref 21. Madden JL, Kandalaft SI: Electrocoagulation as a primary curative method in the treatment of carcinoma of the rectum . Surg Gynecol Obstet 1983;157:164-179. 22. Mlasowsky B, Duben W, Jung D: Cryosurgery for palliation of rectal tumours . J Exp Clin Cancer Res 1985;4:81-83. 23. Osborne DR, Higgins AF, Hobbs KEF: Cryosurgery in the management of rectal tumours . Br J Surg 1978;65:859-861.Crossref 24. Papilon J: New prospects in the conservative treatment of rectal cancer . Dis Colon Rectum 1984;27:695-700.Crossref 25. Sischy B: The place of radiotherapy in the management of rectal adenocarcinoma . Cancer 1982;50:2631-2637. 26. Puthawala AA, Syded AMN, Gates TC, et al: Definitive treatment of extensive anorectal carcinoma by external and interstitial irradiation . Cancer 1982;50:1746-1750.Crossref 27. Kellokumpu I, Husa A: Colorectal adenomas: Morphologic features and the risk of developing metachronous adenomas and carcinomas in the colorectum . Scand J Gastroenterol 1987;22:833-841.Crossref 28. Christenson CE, Nemer FD, Schottler JL, et al: Villous adenomas of the rectum: The accuracy of clinical assessment . Acta Med Scand 1981;210:187-192. 29. Stulc JP, Petrelli NJ, Herrera L, et al: Colorectal villous and tubulovillous adenomas equal to or greater than four centimeters . Ann Surg 1987;207:65-71.Crossref 30. Nivatvongs S, Nicholson JD, Rothenberger DA, et al: Villous adenomas of the rectum: The accuracy of clinical assessment . Surgery 1980;87:549-551. 31. Boley SJ, Sammartano R, Brandt LJ, et al: Vascular ectasias of the colon . Surg Gynecol Obstet 1979;149:353-359. 32. Mathus-Vliegen EM, Tytgat GN: ND:YAG laser photocoagulation in colorectal adenoma: Evaluation of its safety, usefulness, and efficacy . Gastroenterology 1986;90:1865-1873. 33. Mathus-Vliegen EMH: Complications and pitfalls of laser therapy . Endoscopy 1986;18:69-72.Crossref

Journal

Archives of Surgery – American Medical Association

Published: Jun 1, 1989

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