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Background/Aim: We have reported that mass leukocyte removal from circulating blood in patients with ulcerative colitis (UC) by ultracentrifugal cell separator could reduce their symptoms and macroscopic/microscopic inflammation in their colon. This method, namely centrifugal leukocyte apheresis (CFLA), is going to be widely accepted as an alternative therapy for refractory UC patients in Japan. In this study, we analyzed our experience of CFLA for patients with UC who did not respond conventional glucocrticoid administrations, to specify the standard protocol and indication of CFLA treatment for UC patients. Patients/Methods: Through 1995 to 1999, we have experienced 51 patients who underwent CFLA in Asahikawa Medical College Hospital. CFLA using Multi Component System (Haemonetics, Braintree, MA) was performed to remove 2 to 3 billions of leukocytes from circulating blood through single venous access. This CFLA was undergone at once a week, and repeated for 3 to 8 weeks until the patient got into remission. Relationship between patients' characteristics (disease duration, disease extent, concomitant drugs administrated, pretreatment disease activity (evaluated by clinical activity index; CAl) ) and results of CFLA were analyzed by logistic regression analysis. Results: During CFLA treatment, mean CAl of these patients were gradually decreased and no remarkable side effects were noted. Cumulative remission-inducing rates (RIR) (remission is defined as CAl

Background: The ileum is frequently affected site of the small intestine in Crohn's disease (CD). However, precise evaluation of disease activity is sometimes difficult by small bowel enteroclysis (SBE) because of multiple overlapping loops. We have reported the usefulness of balloon occluded endoscopic retrograde ileography (ERIG) that is a combination of colonoscopic and radiological ileal examination for the evaluation of the disease activity not only in the colon but also in the distal ileum at one procedure (Taruishi M. et al. Radiology; in press). Aim: To evaluate weather ERIG alone can represent the disease activity of the whole small intestine without SBE information. Patients and Methods: Between May 1990 and May 1999, 50 times of both ERIG and SBE were performed within two weeks in 33 cases of known CD. Three cases were colitis, 12 were ileocolitis and 18 were ileitis type of CD. Written informed consent was obtained. Briefly, ERIG procedures were as follows. Total colonoscopy was performed, followed by intubation to the ileum. After a guide wire was introduced through the forceps channel into the ileum, only colonoscope was removed. Silicon balloon tube was inserted into the terminal ileum and fixed by the expanded balloon. After barium surfate and air was injected followed by several turning of position, double contrasted radiography was obtained. Disease activity was diagnosed independently on ERIG and SBE.We compared the disease activity assessed by ERIG with that by SBE. Results: Of 50 procedures, both ERIG and SBE revealed identical CD activity; active disease in 25 procedures and remission in 9. On the other hand, in 10 procedures ERIG showed active disease but SBE did not, and SBE showed active disease but ERIG did not in 6 procedures. ERIG could represent and evaluate the disease activity of whole small bowel in 44 (88%) of 50 procedures. The reasons to fail in evaluating the disease activity by ERIG alone were visualization of only short part of the distal ileum (less than about 100 cm) in 4 procedures, severe stricture in 1 procedure and active disease affected only in the jejunum and remission in the ileum in 1 procedure. Conclusion: Because most CD affected distal ileum, ERIG could represent the disease activity of CD not only in the colon but also in the whole small bowel, and assess it at one procedure without SBE.