Photodynamic Therapy of Rectum Stump in Patients with Ulcerative Proctitis

Abstract

INTRODUCTION: Ulcerative colitis is a severe disease significantly reducing the patient’s quality of life. Approximately one third of patients per year suffering from this disease have indications for a surgical treatment — colectomy with ileostomy. Subsequently, not all patients appear suitable for reconstructive surgery, for which reason they are doomed to a life-long ileostomy. These facts stimulate us to search for new methods of treatment of the rectal stump remaining after colectomy. In this study, 10 patients having been operated for ulcerative colitis and having rectal proctitis, underwent a single session of photodynamic therapy. The effectiveness of photodynamic therapy was controlled before the session and one month after it using rectoscopy with rectal mucosa biopsy. Endoscopy results were evaluated on Shroeder and UCEIS scales. The results of histological examination were evaluated on Geboes scale. Maximum accumulation of Photoditazin in rectal stump affected with ulcerative proctitis, was determined after 1.5–2 hours. Upon achievement of this maximum, fluorescence of the rectal mucosa 10.8 times exceeded the initial level, while in the intact tissues, fluorescence increases only 2.8 times. After a session of photodynamic therapy, the level of fluorescence of the rectal mucosa reduced 3.11 times, which indicates a photochemical reaction (positive photobleaching) in the tissue. In evaluation of effectiveness of photodynamic therapy after a month, 9 patients of 10 showed improvement of endoscopic and histologic picture. In 2 patients, remission was achieved, in 7, the activity of ulcerative proctitis declined from moderate to mild level. In one patient, no changes were revealed on evaluated scales. In 90% of patients, a single session of photodynamic therapy showed a positive effect, but taking into account a small sample size and the absence of control group, further data collection with subsequent statistical analysis is planned. CONCLUSION: Photodynamic therapy of rectal stump in the operated patients with ulcerative proctitis can be considered an additional method of treatment and preparation for reconstructive surgery for formation of ileorectal anastomosis.