Endoscopic transanal rectal mucosal ablation in the surgical treatment of ulcerative colitis: preliminary results of a novel technique.
OBJECTIVE
We describe a new technique that endoscopically eradicates rectal stump mucosa after total colectomy for ulcerative colitis.


METHODS
Seven patients (5 males; median age, 56 (range, 36-72) years) underwent attempted endoscopic transanal rectal mucosal ablation using the 28-French-gauge urologic resectoscope, either at the time of total colectomy and ileostomy for failed medical therapy (5 patients) or as an alternative to completion proctectomy (2 patients) with rectal stump discharge. All had declined restorative proctocolectomy. Clinical, endoscopic, and histologic follow-up was undertaken during a mean of 15 (range, 3-28) months.


RESULTS
The operative technique evolved during these cases; mucosal ablation was successfully performed leaving a denuded muscular rectal tube in situ in six patients. Mean operative time was 45 minutes. Postoperative endoscopic surveillance has not demonstrated any viable rectal mucosa in these six patients, with only granulation tissue detected histologically. Narrowing of the rectal tube has occurred in two patients. Although all patients report insignificant rectal discharge, urinary and sexual function have remained unchanged.


CONCLUSIONS
Diathermy ablation of the rectal mucosa via endoscopic transanal rectal mucosal ablation avoids the complications of pelvic dissection and might offer an effective alternative to proctectomy for ulcerative colitis.
Forshaw
Matthew J
MJ
Department of Surgery, Darent Valley Hospital, Darenth Wood Road, Dartford, Kent, United Kingdom.
Buchanan
Gordon N
GN
Murali
Kothandaraman
K
Stewart
Mark
M
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome