Rectal stump management in paediatric ulcerative colitis—An international survey for the ESPGHAN PORTO IBD group study

Objective To evaluate current international clinical practice in the assessment and management of rectal stump disease activity following colectomy in paediatric ulcerative colitis (UC). Methods A web‐based survey comprising 18 questions was distributed to paediatric gastroenterologists via European Porto IBD interest group and North America and the United Kingdom PIBD network groups over 6 months. The questionnaire recorded centre demographics, colectomy practices, rectal stump assessment methods, and management approaches. Responses were analysed using descriptive statistics with subgroup analysis by continent and centre size. Results Eighty paediatric gastroenterologists from 24 countries completed the survey. Most centres ( n = 62, 78%) reported fewer than five colectomies annually, with 59% indicating that all patients retained a rectal stump for at least 3 months post‐colectomy. Only 11% of centres had a formal protocol for rectal stump management. Clinical assessment tools varied, with 39% using none, and the remainder favouring PUCAI or Physician's Global Assessment. Frank rectal bleeding and painful rectal discharge were rated as the most significant symptoms. Endoscopy and histology were the most common investigations. Rectal therapy was the preferred first‐line treatment for rectal stump disease recurrence, followed by systemic therapy and observation. There was wide variation in estimates of rectal disease activity at 6 months post‐colectomy. Conclusions There is considerable international variation and lack of standardisation in the management of rectal stump disease in paediatric UC. These findings underscore the need for evidence‐based guidelines and collaborative research to optimise care for this understudied population.