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Bệnh Học (phía dưới bên trái) bắt đầu điều trị bằng laser nội soi của khu vực không cuống; (trên bên phải) chắc chắn rằng khu vực được kiểm tra trong retroflexion bởi vì khối u thường không nhìn thấy cuối cùng vào xem và (phía dưới bên trái) điều trị | Lasers in Endoscopy 97 Figure 13.3. Treatment of rectal adenoma polypoid and sessile components. top left remove polypoid portion via standard snare technique specimen to Pathology bottom left begin endoscopic laser treatment of sessile area top right make sure area is examined in retroflexion because tumor often is not seen in end-on view and bottom left treat if necessary in retroflexion and torque scope to get best angle avoid scope shaft may need to alter patient position. Photodynamic therapy. Largest clinical experience to date. Best technique for circumferential areas of Barrett s esophagus 3 cm in length. Small area of Barrett s i.e. finger-like projections 3 cm circumferential involvement can be treated with Nd YAG laser. Risks. Perforation stricture common Barrett s epithelium retained under new squamous mucosa. Bottom line. Still experimental. Patients with large areas of Barrett s with severe dysplasia who are acceptable risks should undergo surgery. Early Gastric Carcinoma Rare in the U.S. Small lesions 3 cm. Japanese studies show good results with PDT and Nd YAG used for superficial carcinoma staged by endoscopic ultrasound in poor operative risk patients. Raised lesions with discrete margins Nd YAG. Flat ulcerated lesions with indiscrete margins PDT. Complete remission at 2 years in 80 . Advanced Gastric Carcinoma YAG laser generally not very helpful. Minimal PDT experience stents best for extensive antral lesions that cause partial gastric outlet obstruction. 13 98 Gastrointestinal Endoscopy Table 13.3. Complications of endoscopic laser therapy for colorectal cancers Number Pain requiring narcotic analgesia 3 0.6 Bleeding requiring transfusion 10 2.0 10 ml 16 3.2 Perforation local 15 3.0 Perforation free 5 1.0 Anal stenosis 21 4.2 Fecal incontinence 5 1.0 Need for surgery 19 3.8 Death 6 1.2 Survey by author involving 500 patients. Contributors to the survey Drs. Harvey Jacobs Stephen Bown Richard Dwyer David Fleischer Victor Grossier and Mark .