Endoscopic Transanal Rectal Mucosal Ablation in the Surgical Treatment of Ulcerative Colitis: Preliminary Results of a Novel Technique

Abstract

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.

Stapled Mucosectomy: An Alternative Technique for the Removal of Retained Rectal Mucosa after Ileal Pouch-Anal Anastomosis

“…Thus, the eradication of the rectal mucosa to provide complete surgical care for such patients has been a major concern for surgeons. To date, a number of techniques have been described and these include chemical debridement,5 ultrasonic fragmentation,6 transanal mucosectomy using an ultrasonically activated scalpel7 and endoscopic transanal mucosal ablation with an urologic resectoscope 8. However, these techniques either result in ablation of the rectal mucosa or complete mucosal destruction so that the histolopathologic examination can not always be thoroughly assessed 4,11.…”

Combined endoscopic trans-anal rectal mucosal ablation and laparoscopic partial proctectomy for ulcerative colitis – a new procedure

“…Significant persistent anal leakage after ETARMA is not demonstrated consistently. 2 All patients experience some minor discharge following ETARMA; however, this does not require the use of pads. Regular postoperative selfdigitation encourages drainage of any local collections and will help to prevent continued leakage.…”

“…There remains the possibility of missing microscopic islands of dysplastic rectal mucosal cells and the development of postoperative anal stenosis and anal leakage. 2,5 Provided that the rectal stump is kept short (less than 7 cm), pelvic sepsis secondary to collections of trapped exudate is not a regular complication. Significant persistent anal leakage after ETARMA is not demonstrated consistently.…”

“…Only 50% of such patients consent to a further definitive treatment option. 1,2 Furthermore, pelvic dissection is associated with significant risks including pelvic sepsis, urinary and sexual dysfunction, haemorrhage, perineal wound complications and delayed mobilisation.…”

Transanal endoscopic microsurgery: a new technique for completion proctectomy

“…Laparoscopic and robotic techniques may reduce the morbidity from the open abdominal component and intersphincteric proctectomy improves wound healing and preserves nerve function but is technically difficult or impossible for a rectal stump of more than 8 cm . Endoscopic transanal diathermy ablation of the rectal mucosa has been described but resulted in persistent mucus discharge .…”