{
  "abstract": "Introduction Surveillance of the retained rectal stump following subtotal colectomy is recommended at 1–3-year intervals for patients at increased risk of colitis-associated dysplasia or colorectal cancer, with deferral to 10 years in low-risk patients. 1 Despite this, symptoms related to ongoing inflammation or diversion proctitis are common. This study aimed to evaluate the fate of the retained rectum following colectomy for inflammatory bowel disease (IBD) in a District General Hospital.Methods Retrospective review of patients undergoing colectomy for IBD between January 2007 and December 2021 with follow-up data collected until August 2025.Results Seventy-eight patients underwent colectomy for IBD ( table 1). Forty-three patients (55%) underwent rectal stump surveillance, accounting for 90 proctoscopies at a median interval of 17 months (IQR 7–37), while 35 patients (45%) were lost to surveillance follow-up. Histology demonstrated severe proctitis in 30/90 procedures (33.3%), diversion proctitis in 28/90 (31.1%), remission in 20/90 (22.2%), and dysplasia in 1/90 (1.1%).Twenty-one patients (27%) were classified as high risk for dysplasia; of these, 15 (71.4%) underwent surveillance with a median of 3 procedures per patient (range 1–6) at a median interval of 15 months (IQR 9–21). Three high-risk patients underwent completion proctectomy at 9, 25, and 115 months, and one underwent proctectomy with restorative IPAA at 9 months.Two patients developed metastatic colorectal cancer during follow-up. One patient with ulcerative colitis and colorectal cancer at initial colectomy missed scheduled surveillance during the COVID-19 pandemic and presented with metastatic disease eight years later. The second patient, with refractory ulcerative colitis and dysplasia, developed dysplasia in the rectal stump at 18 months and metastatic adenocarcinoma by 52 months post-colectomy, despite planned completion proctectomy at 26 months.Reference East JE, et al. Gut 2025;0:1–34.Abstract P256 Table 1DemographicsDiagnosesUlcerative Colitis 73/78 (94%) Crohn’s Disease 4/78 (5%) Collagenous colitis 1/78 (1%)Female : Male1.4 : 1Median age at colectomy49 years (43 – 64)Subsequent ileal-pouch anal anastomosis (IPAA)16/78 (20.5%), median interval 13 months (10 – 40)Completion proctectomy25/78 (35%), median interval 47 months (21 – 66)",
  "authors": [
    {
      "affiliations": [
        "Maidstone and Tunbridge Wells NHS Trust, Tonbridge, United Kingdom"
      ],
      "name": "Silas Danielraj Joshua Muthuchand"
    },
    {
      "affiliations": [
        "Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire"
      ],
      "name": "Ania Przedlacka"
    },
    {
      "affiliations": [
        "Maidstone and Tunbridge Wells NHS Trust, Tonbridge, United Kingdom"
      ],
      "name": "Charles Bailey"
    },
    {
      "affiliations": [
        "Maidstone and Tunbridge Wells NHS Trust, Tonbridge, United Kingdom"
      ],
      "name": "Daniel Lawes"
    },
    {
      "affiliations": [
        "Maidstone and Tunbridge Wells NHS Trust, Tonbridge, United Kingdom"
      ],
      "name": "Paul Blaker"
    }
  ],
  "title": "P256 Fate of the rectal stump following colectomy for inflammatory bowel disease in district general hospital practice",
  "uid": "f403bae7-6dc9-598a-8003-4f8bd0adbf71"
}