since the special quartz fiberoptic transmission system was developed , it is possible to apply laser energy through a flexible fiber endoscope .
after the first use of the endoscopic laser for the treatment of active gastrointestinal bleeding in 1975 , by fruhmorgen , endoscopic laser therapy has been widely used , not only for the treatment of acute gastrointestinal bleeding and non - bleeding gastrointestinal angiodysplasia , but also for the treatment of gastrointestinal neoplasm . in our experience ,
the use of the endoscopic nd - yag laser for the removal of protruding , broad - based polyps of the stomach is efficient and safe .
twelve patients with broad - based gastric polyps which protruded submitted to the removal of the polyps with an endoscopic nd - yag laser ( table 1 ) .
the quartz fiber with a polyethylene sheath was guided through the biopsy channel of a prototype panendoscope , gif - q10 , and gif-2 t .
a filtering lens was attached to the eyepiece of the endoscope to prevent damage to the operator s eye from the laser beam .
multiple 0.5 sec pulse irradiation of the nd - yag laser ( medilas yag , germany ) , with a power of 60 watts , at the tip of the quartz fiber were utilized .
the flexible light guided assembly was quartz fiber with a diameter of 600 m , a length of 34 m , and a divergence angle of 8 .
the application number of laser energy was from 6 to 58 depending on the location and size of the lesion ( table 1 ) .
after the laser application , an h2 receptor antagonist ( ranitidine ) for laser - induced ulcers was administered perorally for four weeks routinely , and all patients except one were submitted to a follow - up gastroscopy 1 week and 5 weeks after the laser application ( table 2 ) .
from january to november 1985 , endoscopic nd - yag laser treatment was utilized to eradicate gastric polyp in 12 patients .
the male to female ratio was 1:1.4 ( male : 5 , female : 7 ) , and ranging , in age from 34 to 70 with a mean of 50 years ( table 1 ) . the most frequent presenting symptoms initiating the diagnostic work up were epigastric discomfort , indigestion or nausea .
the presence of gastric polyp was confirmed by endoscopy and by upper gastrointestinal contrast study .
the most frequent location for the polyp was in the antrum ( 7 cases ) and followed by the fundus ( 5 cases ) .
multiple polyps were noted in two cases and they were located in the body or antrum of the stomach .
the number of polyps of type i ( yamada classification ) was 7 , type ii , 5 ; type iii , 2 ; and type iv , 1 ( table 1 ) .
the size of the lesions treated with the laser ranged from 0.2 cm to 1.0 cm in diameter .
the application number of laser energy was from 6 to 58 , while the small lesions of the 10 patients were completely ablated by the first endoscopic laser therapy , the other two lesions of the two patients required repetitive laser treatment to achieve complete ablation of the lesion ( table 2 ) . during and after endoscopic laser therapy , no complication were encountered except for mild bleeding and occasional mild epigastric burning pain in the case of two of the patients .
follow - up endoscopy in all patients , which was done at the ends of the first and fifth weeks after the laser application , revealed no new polyp formation or recurrence .
all patients had residual ulcers at the end of the first week postopolypectomy , but all ulcers were healed by the end of the fifth week of follow - up ( table 2 ) .
with the development of a flexible fiberoptic system , diagnostic and therapeutic endoscopy is playing a major role in the management of gastrointestinal polyps .
a review of several studies has revealed the incidence of adenomatous polyps of the stomach to be 0.4% to 0.7% .
although the term gastric polyp has been used to refer to any protrusion into the gastric lumen , recent experience has led to classification schemes based on topographic , histologic , and vital staing criteria . the most frequently encountered gastric polyp , hyperplastic or regenerative polyp , is reported to contain malignancy rarely . the incidence of malignant change in adenomatous polyp has been reported to be from 6 to 75 percent .
the malignant potential appears to be related to the size of the polyp , with larger adenoms ( particularly those greater than 2 cm ) having a greater potential for malignant change . at the mayo clinic
, patients were offered endoscopic polypectomy if the gastric polyps had been diagnosed and they met one of the following criteria . 

unchanged or enlarging gastric polyp on serial upper gastrointestinal contrast studies.expected noncomplaint patient follow-up.previous gastric surgical procedure with the presence of a new polyp.a gastric polyp in a patient known to have pernicious anemia . unchanged or enlarging gastric polyp on serial upper gastrointestinal contrast studies .
previous gastric surgical procedure with the presence of a new polyp . a gastric polyp in a patient known to have pernicious anemia .
one of the known procedures for the ablation of gastric polyps by endoscope is electro - coagulation with a snare .
the complications that can ensue from this snare excision method are bleeding , perforations and ulceration , and broad based , protruding polyps ( such as the yamada classification type i or type ii lesions ) are technically difficult to excise by this method . in the last few years , the use of endoscopic laser for the therapy of gastrointestinal disease has grown exponentially , due to its therapeutic benefit and safety . the nd - yag lasers are no longer thought of as being investigational for therapy .
there are 3 main indications for their use : 
 acute gastrointestinal bleeding.non-bleeding gastrointestinal angiodysplasia.gastrointestinal neoplasm , where palliation is needed . acute gastrointestinal bleeding .
the application of the nd - yag laser in the treatment of gastrointestinal disorder is still in an evolutionary process .
one area of interest is the treatment of inoperable neoplasm of the esophagus , stomach , duodenum , and colon .
palliative therapy with an nd - yag laser is indicated for obstructing symptoms , bleeding from the malignancy , and tumor bulk .
the patients with polyps of the gastrointestinal tract , also , have been successfully treated with it .
the number of serious complications , which can occur during therapy with laser energy , have been impressively few .
rosch and fruhmorgen have reported the efficacy of using the endoscopic argon laser for the gastric borderline lesions and early , protruding gastric carcinoma .
however , there is a tendency toward using the nd - yag laser because of its greater power output .
anthony a. goossens and his fellow investigators reported that the argon laser emits a beam which has lower surface absorption and tissue healing than other lasers , making it ideal for ophthalmological work where high surface tissue absorption is not desired and thermal coagulation at shallow depth is , but since nd - yag lasers emit a beam which has low surface absorption and penetrates tissue to more depth than the argon laser beam does , there is enough energy to overcome the dynamic condition of tissue to allow more deep thermal coagulation , tissue destruction , and tumor removal ( table 3 ) .
osamu kato and his associates reported a case of broad - based , protruding gastric borderline lesions , which was successfully treated , using the endoscopic nd - yag laser .
we ablated broad - based , protruding gastric polyps of 12 patients without complications , such as the bleeding or perforations , which can ensue from snare excision .
we , therefore , emphasize that endoscopic nd - yag laser therapy is an effective and safe method of treatment for ablation of broad - based , protruding polyps of the stomach .
however , long term follow up study should be done , because laser therapy precludes a total biopsy .
 with the development of a special quartz fiberoptic transmission system , the application of laser energy through an endoscope became possible . 
 now , endoscopic laser therapy is widely used for gastrointestinal bleeding , and gastrointestinal neoplasm , and we have removed broad - based gastric polyps using an endoscopic nd : yag laser in 12 patients between january and december 1985.the size of the polyps ranged from 0.2 cm to 1.0 cm in diameter . 
 the most frequent location for the polyp was in the antrum ( 7 cases ) and followed by the fundus ( 5 cases).the application number of laser energy was from 6 to 58 and the small lesions of the 10 patients were completely ablated by the first endoscopic laser therapy.follow-up endoscopy in all patients revealed no new polyp formation , but all patients had a residual ulcer at the end of the first week post polypectomy , and ulcers were healed by the fifth week of follow up . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION