Endoscopic mucosal resection for pouch prolapse

no. The evidence for endoscopic mucosal resection (or any endoscopic technique) in pouch prolapse is confined to case-level reports and small heterogeneous series, with no controlled comparisons ^1,2. the only synthesized data come from a systematic review/meta-analysis of perineal salvage surgery reporting success rates of 75–100% across just three studies with high heterogeneity (I²=95.7%) and a paucity of prolapse-type–specific data ¹. ^1,2

What is known:

• Endoscopic management of pouch prolapse is described only in novel single-patient reports (e.g., band ligation with hypertonic glucose cushion, hot-snare resection of small prolapse). ²
• The pooled perineal salvage meta-analysis rested on very few studies with wide confidence intervals, severe heterogeneity (I²=95.7%), and no distinction of prolapse subtype for most cohorts. ¹
• Surgical prolapse treatments (pexy, mesh, mucosal excision) carry notable recurrence, with pouch failure requiring conversion to continent ileostomy in some patients. ²

What is unknown / caveats:

• No retrieved study isolates endoscopic mucosal resection as a discrete intervention for prolapse
• All data are retrospective/anecdotal with no control groups or RCTs
• Reported success rates derive from ≤3 small heterogeneous studies
• Whether any endoscopic technique changes durable prolapse outcomes cannot be established from the retrieved evidence.

References

1. Ray-Offor E, Garoufalia Z, Emile SH, Rogers P, Horesh N, Gefen R, Zhou P, DaSilva G, Strassmann V, Wexner SD. Perineal salvage surgery for prolapse of ileal pouch anal anastomosis: Systematic review and meta-analysis. Colorectal Dis. 2025;27:e70202. PMID: 40855474.

2. Shen B. Endoscopic band ligation with hypertonic glucose cushion in the treatment of ileal pouch prolapse. Gastroenterol Rep (Oxf). 2021;9:480-482. PMID: 34733536.

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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.