Endoscopic ablative therapy of the proctosigmoideal neoplastic lesions – a pilot study


Authors: P. Mlkvý 1;  I. Čavarga 1;  A. Mateášik 2
Authors‘ workplace: Oddelenie laserovej medicíny, Onkologický ústav sv. Alžběty, Bratislava 1;  Medzinárodné laserové centrum, Bratislava 2
Published in: Gastroent Hepatol 2012; 66(5): 357-363
Category: Gastrointestinal Oncology: Original Article

Overview

Purpose and objectives:
Endoscopic possibilities of ablative treatment with curative intention of rectosigmoid precancerous lesions characterized as flat or broad-based adenomas, multifocal lesions and lateral spreading lesions after incomplete endo­scopic resection.

Methods:
Out-patient based ablative treatment using argon plasma coagulation (APC), photodynamic therapy with delta aminolevulinic acid as a photosensitizer (PDT-ALA) or as a combination of both of them in patients with rectosigmoid lesions within a period of 7 years of regular post-therapeutic follow-up controls.

Results:
34 patients with average age 59 ­years with rectosigmoid lesions (30 adenomas with various degrees of dysplasia, 4 early cancers), after fulfilling “low risk criteria” for endoscopic treatment, were treated using APC (on average 3 sessions), one-off treatment with PDT-ALA or a combination of both of them. Treatment was successful in 31 patients (92%), 3 patients (8%) underwent surgery because of persistent histological positivity in the base (2 high grade dysplasia, 1 carcinoma). We observed minor bleeding in 5 patients (8.5%) and abdominal discomfort caused by gas insufflation in 13 APC patients (48%). No serious complications were observed. Patients were followed up every 6 months for the first 2 years and later at yearly intervals.

Conclusion:
Ablative treatment of these lesions using APC, PDT-ALA or a combination of both of them is an effective and safe therapeutic modality. Out-patient based treatment and the reasonable costs are additional advantages.

Key words:
photochemotherapy – colorectal neoplasms – ablation techniques

The author declares he has no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
26. 9. 2012

Accepted:
7. 10. 2012


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Labels
Paediatric gastroenterology Gastroenterology and hepatology Surgery

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