Poorly controlled ulcerative colitis treated by colectomy during remission induced by extracorporeal leukocyte removal therapy

Abstract

Both monocyte-granulocytapheresis (M-GCAP) and leukocytapheresis (LCAP) are categorized as extracorporeal leukocyte removal therapies (ECCTs). These therapies have been recognized as efficient adjuncts for patients of steroid-resistant ulcerative colitis (UC). This study aimed to consider the adaptation and the limitation of these new therapies from the clinical standpoint based on a case of UC showing strong resistance to high-dose continuous steroid injection therapy. The patient successfully underwent a scheduled colectomy while maintaining remission after applying M-GCAP and LCAP independently. Surgical therapy was chosen because of a deep ulcer in the patient's sigmoid colon, which was assumed to constitute a future risk for perforation. This case suggests that combining ECCT with steroid therapy can maintain such poorly controlled and high-risk UC patients safely for the scheduled colectomy while improving the prognosis by reducing the dosage of steroid efficiently prior to operation.

Activated platelets as a possible early marker to predict clinical efficacy of leukocytapheresis in severe ulcerative colitis patients

“…We hypothesized that the platelet reduction achieved during LCAP might amplify its therapeutic efficiency for UC patients with severe mucosal damage by restoring blood microcirculation in the colonic mucosa. 24 The results of the endoscopic evaluation in this study seemed to support this hypothesis, since LCAP induced a significant improvement only in the factor "mucosal damage" among EI components.…”

Leukocyte removal therapy for ulcerative colitis does not affect postoperative complications

“…However, it seems to be ineffective for patients with a long disease history. 11,12 Sawada et al 13 reported that LCAP is effective and safe for treating patients with severe or fulminant UC with toxic megacolon (TM). Nevertheless, LCAP should be considered as an option only for the management of TM or a bridging therapy to surgery, thereby avoiding a high-risk emergency colectomy.…”

“…Of those, the mean CAI score for the LRT group (8; range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] was significantly greater than that for the without LRT group (7.5; range, 2-16). We found infectious complications in 6 (13.0%) of 46 patients in the LRT group and 10 (6.8%) of 147 in the without LRT group, a difference that was not significant.…”

“…The mean CAI score for those in the LRT group (8; range, 4-19) was significantly greater than that of those in the without LRT Of all 387 patients, 48 (12.4%) underwent only a total colectomy as the initial operation (Table 8). In these patients, the mean CAI score in the LRT group was [8][9][10][11][12][13][14][15][16][17][18][19] and that in the without LRT group was also 16 (range, 7-19); thus no statistically significant difference was found. Infectious complications were observed in three (20.0%) patients in the LRT group and in two (6.1%) in the without LRT group, an nonsignificant difference.…”

Cytapheresis as a Non-Pharmacological Therapy for Inflammatory Bowel Disease

“…A recent unpublished randomized controlled study comparing intensive and once a week regimen showed that intensive treatment, which consists of two aphereses in a week for 5 consecutive weeks, results in higher remission rates according to both clinical and endoscopic criteria and shorter duration before getting clinical response. Although, for steroid-resistant severe UC, intravenous infusion therapy of cyclosporine has been widely accepted as an adjunct therapy [42], a large proportion of patients may have surgery in future years. Clinical experience so far suggests that cytapheresis has superior efficiency as a non-pharmacological immunomodulative therapy for steroid-resistant UC patients before colectomy [1][2][3][4].…”