Symptomatic rectal stump in UC: resection or proctocolectomy

What is known

• The rectal stump can be a source of continuing symptoms and carries long-term risk of malignant transformation, and not all patients are suitable for reconstructive surgery. ¹
• Endoscopic transanal rectal mucosal ablation is reported only as preliminary results of a novel technique, avoiding pelvic dissection and its associated risks. ¹
• Surveillance recommendations for the retained rectal stump vary widely, with intervals ranging from 6 months to 2 years or risk stratification. ²

What is unknown / caveats

• No head-to-head data on endoscopic ablation/resection vs definitive proctocolectomy for a symptomatic stump
• Endoscopic ablation evidence is limited to preliminary results of a single novel technique
• The excerpts do not report comparative efficacy, symptom resolution, or cancer-prevention outcomes between the two approaches.

References

1. Forshaw MJ, Buchanan GN, Murali K, Stewart M. Endoscopic transanal rectal mucosal ablation in the surgical treatment of ulcerative colitis: preliminary results of a novel technique. Dis Colon Rectum. 2005;48:1269-74. PMID: 15868238.

2. Hennessy O, Egan L, Joyce M. Subtotal colectomy in ulcerative colitis-long term considerations for the rectal stump. World J Gastrointest Surg. 2021;13:198-209. PMID: 33643539.

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Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.