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Introduction

Refractory ulcerative proctitis (UP) represents a clinical conundrum, often necessitating systemic therapy for localised disease. Faecal microbiota transplant (FMT) has proven efficacy for remission induction ulcerative colitis, yet has not been evaluated in UP.

Aims & Methods

Aims: To undertake a prospective open-label study examining the safety and efficacy of Faecal Microbiota Transplant (FMT) enema therapy for management of resistant ulcerative proctitis (UP).
Methods: Patients with mild-moderately active UP (total Mayo score 3-10 with endoscopic Mayo subscore ≥ 1) resistant to 5-Aminosalicylates (5-ASA) were prospectively enrolled. After an initial conditioning phase of vancomycin therapy and dietary education, participants received six anaerobically prepared single donor FMT retention enemas over an eight-week period. The primary end point was clinical and endoscopic remission (total Mayo score ≤2) at 8 weeks. Secondary endpoints included safety, histological remission and patient reported outcomes (Inflammatory Bowel Disease Questionnaire). Disease activity assessments including clinical, endoscopic, histological and quality of life measures were performed at week 0 and week 8 to assess response to FMT therapy. Systematic adverse event reporting was completed at each study visit.

Results

Among 30 participants enrolled (mean age 41 years, 17 (57%) women) , 26 completed the study protocol. Clinical and endoscopic remission was achieved in 10 patients (33.3%).
Serious adverse events necessitating study withdrawal occurred in 3 enrolled patients due to flare of UP (n=2) and Clostridioides difficile (C. difficile) colitis (n=1).

Conclusion

FMT enema therapy was well tolerated and demonstrated efficacy in inducing clinical and endoscopic remission in resistant UK. The role of antibiotic preconditioning of recipients and choice of antibiotic therapy remains unclear. Further controlled studies in this area are warranted.

References

Disclosure

SSR does not have any conflicts of interest to declare. This project did not receive any financial support from any organisation or institution. FMT enemas were supplied in kind by BiomeBank. CKR has received research funding from AstraZeneca, Merck Sharp & Dohme, Eli Lilly and Company, Novartis, and Sanofi and has participated in advisory boards for Allergan (now AbbVie). SPC has received advisory, speaking fees, or research support from Ferring, Shire, Microbiotica and Janssen. RVB has received grant/research support/speaker fees (all paid to employer for research support): AbbVie, Ferring, Janssen, Shire, Takeda, Emerge Health. SPC and RVB are shareholders in BiomeBank.

EXAMINING THE ROLE OF FAECAL MICROBIOTA TRANSPLANTATION (FMT) TO INDUCE REMISSION IN RESISTANT ULCERATIVE PROCTITIS (UP)

Sreecanth Raja 1, Robert Bryant 1, Sam Costello 2, Christopher K. Rayner 3

1 The Queen Elizabeth Hospital, Woodville South, Australia

2 The Queen Elizabeth Hospital, Adelaide, Australia

3 Royal Adelaide Hospital, Adelaide, Australia

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

PP 05 IBD (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Presentation

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What can we learn from monogenic IBD

Alexo Muise 1

1 SickKids Research Institute, Toronto, Canada

Event

UEG Week Berlin 2025

Topics

IBD Mechanisms & Personalised Medicine

Session

The art of making clinical research precise: Predicting therapy response in IBD

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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DISTINCTIVE ASPECTS OF DEPRESSED TYPE OF COLORECTAL NEOPLASMS OBSERVED IN MAGNIFYING ENDOSCOPY AND ENDOCYTOSCOPY

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Introduction

At present, there are three developmental pathways for colorectal cancers, namely, the adenoma-carcinoma sequence, serrated pathway, and de novo pathway. The adenomatous route of colorectal cancer carcinogenesis has been extensively reviewed in the literature. Conversely, the de novo pathway, which leads depressed type polyps to colorectal cancer, lacking an adenomatous phase, recently has garnered increasing attention. Research has indicated that nonpolypoid lesions demonstrate a greater potential for malignancy, underscoring the need for their early detection. This study aims to explore the endoscopic characteristics of depressed type colorectal neoplasms by using magnifying endoscopy (pit pattern classification) and endocytoscopy (EC classification). Both the structural and cellular atypias can be observed in vivo, thus enabling more comprehensive evaluation of the disease.

Aims & Methods

A total of 40719 colorectal neoplasms resected endoscopically or surgically in our institution from April 2001 to June 2022 were subject of this study. Advanced cancers were excluded. Of these, 1463 lesions were submucosally invasive (T1) carcinomas, 6839 lesions were high-grade dysplasia and 32417 lesions were characterized as low-grade dysplasia. Morphologically, they were divided into 3 types: depressed, flat and protruded type comprising 1.2%, 42.9% and 55.9%, respectively. Specifically, the distinctive features of depressed type neoplasms concerning its pit pattern and EC classification were examined.

Results

Most of the flat (93.3%) and protruded type (94.7%) lesions showed type III _L or IV pit pattern, which are common findings in adenomas.On the other hand, most of the depressed type lesions(92.4%) classified by type III s, V_Ior V _N pit patterns, are typically seen in carcinomas. As for endocytoscopy, most of the flat and protruded type lesions were identified as EC2 corresponding to adenomas. In contrast, a relatively high rate of depressed type lesions was categorized as EC3a (40.0%) and EC3b (52.0%), consistent with invasive carcinomas. The proportion of T1 carcinomas in depressed type lesions was 61.3%, whereas in the flat and protruded type lesions it was 2.9% and 2.9%, respectively. Also, 10% of lesions less than 5mm in diameter were depressed, 0.01% were flat and 0% were protruded.

Conclusion

This investigation has revealed that depressed lesions can be classified in magnifying endoscopy as type III s, V I or V N pit patterns, and as types EC3a or EC3b in endocytoscopy. Lesions that have these features or these pit patterns also have a propensity to invade the submucosal layer even when they are small in size. Despite their elevated malignant potential, depressed type lesions are frequently disregarded, underscoring the critical importance of recognizing their distinctive features and accurately diagnosing lesions based on their morphology, pit pattern, and EC classification.