What is the evidence that endoscopic mucosal resection improves outcomes in patients with 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._