Endoscopic resection of polypoid solitary rectal ulcer: A novel first-line therapeutic strategy using snare-assisted mucosal and fibrosis resection

Abstract

Objectives

To propose a novel first-line endoscopic therapy for treating polypoid lesions in solitary rectal ulcer syndrome (P-SRUS), the rarest and most challenging subtype of SRUS, which encompasses various endoscopic findings including mucosal erythema, superficial or deep ulcers, and polypoid lesions.

Methods

A prospective, single-arm study was conducted on 56 patients with histologically confirmed SRUS and broad-based polypoid lesions in the rectum and anal canal. These patients were referred to the Department of Motility Disorders of the Lower Gastrointestinal Tract. The lesions were removed using snare-assisted mucosal and fibrosis resection. Patients were monitored for clinical and endoscopic responses at 1, 3, 6, and 12 months post-treatment.

Results

The study observed improvement in clinical symptoms, a complete endoscopic response, and the absence of late complications following endoscopic resection. Endoscopic evaluations revealed no recurrence of lesions in the follow-up period.

Conclusion

Endoscopic resection using the snare-assisted mucosal and fibrosis resection method appears to be an effective and safe treatment option for polypoid SRUS. (Clinical Trial Registration Number: IRCT20211101052935N2).