Apheresis systems have been used in inflammatory bowel disease with a view to immunomodulation. The technique employs a system of white cell extraction, filtration and adsorption mainly with two systems: granulocytapheresis and leukocytapheresis. One session weekly for 5-10 consecutive weeks is usually used to induce clinical remission, while a monthly session can be used as maintenance therapy. Evidence from controlled clinical trials does not support the use of this modality in moderate to severe ulcerative colitis, while a lesser grade of evidence supports its use in corticosteroid-dependent ulcerative colitis. Apheresis is safe, with minimal adverse effects. The present article reviews the literature on the efficacy and safety of this technique in the distinct clinical situations in which it can be applied.