Scientific corner

Toxic Megacolon: Background, Pathophysiology, Management Challenges and Solutions

Jiten Desai 1Mohamed Elnaggar 2Ahmed A Hanfy 2Rajkumar Doshi 2

Clin Exp Gastroenterol. 2020 May 19;13:203-210. doi: 10.2147/CEG.S200760. eCollection 2020.

Leukocytapheresis (LCAP) is useful in the management of TM

Scientific corner

Leukocytapheresis (LCAP) for Management
of Fulminant Ulcerative Colitis with
Toxic Megacolon

Koji Sawada 1Akimitsu EgashiraKunio OhnishiKen FukunagaTakeshi KusakaTakashi Shimoyama

Dig Dis Sci 2005 Apr;50(4):767-73. doi: 10.1007/s10620-005-2571-3.

Leukocytapheresis (LCAP) is a method of therapeutic apheresis to remove patients’ peripheral leukocytes by extracorporeal circulation. Previous studies showed that LCAP for the treatment of ulcerative colitis (UC) was more effective and had fewer adverse effects compared to high-dose steroid therapy. However, there are no reports on the application of LCAP for UC patients with toxic megacolon (TM). This study reports the effectiveness and safety of LCAP in treating patients with severe or fulminant UC with TM. Six patients were enrolled in this study and LCAP sessions were performed three times per week for 2 weeks, followed by four further times in the next 4 weeks. After completion of therapy, four patients improved in TM and went into the remission stage of UC. The average Rachmilewitz clinical activity index of these four patients improved from 19.5 to 1. The remaining two patients had to undergo colectomy, however, the symptoms had been mitigated by LCAP and the operations were completed without any problems. These results suggest that LCAP is an additional effective and safe option for TM management in preventing colectomy or for bridging to a safer operation.

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