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

Abstract

Purpose and objectives: Endoscopic possibilities of ablative treatment with curative intention of rectosigmoid pre-cancerous 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), photodyna-mic 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.