The clinical advantage of pan-colonic enema with Compound Qingdai on the remission of extensive ulcerative colitis

Extensive ulcerative colitis (UC) causes diffuse colonic inflammation and is often less responsive to conventional therapies. Topical treatments such as rectal enemas have limited proximal reach, reducing efficacy for pan-colonic disease. Transendoscopic enteral tubing (TET) enables repeated, targeted pan-colonic drug delivery and may enhance the therapeutic effect of traditional Chinese medicine (TCM) enemas. To evaluate the efficacy and safety of TET-assisted pan-colonic retention enema with Compound Qingdai compared with conventional rectal enema in patients with active, extensive UC over a 14-day observation period. 18 patients with active, extensive UC (November 2018–September 2021) were randomized 1:1 to a pan-colonic enema group ( n =9) or a rectal enema group ( n =9). The experimental group received TET enema, and the control group received rectal administration enema. The cut-off point of evaluation was 14 days, observe and compare the clinical intestinal symptoms, disease severity, endoscopic scores, mucosal histopathology scores, laboratory indicators and adverse reactions of the two groups. After 14 days, both groups demonstrated significant improvements in clinical symptoms and modified Mayo scores compared to baseline ( P < 0.05 ), with greater reduction in the pan-colonic group ( P < 0.05 ). The clinical response rates were 100.0% for the pan-colonic group and 66.7% for the rectal group; remission rates were 44.4% and 33.3%, respectively. Regarding the Mayo Endoscopic Subscore (MES), endoscopic mucosal improvement was significant across all intestinal segments in both groups compared to baseline ( P < 0.05 ), with the pan-colonic group exhibiting superior mucosal healing compared to the rectal group ( P < 0.05) . The mucosal healing rate was 77.78% in the pan-colonic group versus 22.22% in the rectal group. Ulcerative Colitis Endoscopic Index of Severity (UCEIS) scores of both distal and proximal colon improved significantly post-treatment in both groups ( P < 0.05 ). Notably, proximal colon improvement was significantly greater in the pan-colonic group ( P < 0.001 ). Histopathological analysis revealed a significant decrease in Geboes scores in both groups after treatment ( P < 0.05 ), with the pan-colonic group showing superior improvement compared to the rectal group ( P < 0.05 ). The blood biochemical indicators, namely Fecal Calprotectin (FC), White Blood Cell (WBC), Platelet count (PLT), Erythrocyte Sedimentation Rate (ESR), C-reactive Protein (CRP), and stool occult blood (OB) score were all decreased after treatment. Moreover, fecal OB score in both groups were significantly decreased ( P <0.05), while FC score in pan-colonic colon group was significantly decreased compared with before treatment ( P <0.001). Neither group showed significant adverse effects ( P >0.05). TET-assisted pan-colonic retention enema with Compound Qingdai achieves superior clinical, endoscopic, and histological outcomes compared with conventional rectal enema in extensive UC, offering a more effective drug delivery method for achieving better inflammation relief and provides a new way for the treatment of UC with TCM.