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Endoscopic Mucosal Resection in Children
David S Vitale1,2, Kelly Wang1, Laith H Jamil1,3,4
1Department of Internal Medicine, Karsh Division of Gastroenterology and Hepatology, Cedars Sinai Medical Center, Los Angeles, CA.
Insights
Endoscopic mucosal resection (EMR) is safe and effective for removing large polyps in children. This study shows high success rates and no adverse events in pediatric EMR cases.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Procedures
- Gastrointestinal Surgery
Background:
- Endoscopic mucosal resection (EMR) is a standard procedure for large polyp removal in adults.
- EMR use in pediatrics is limited due to lower polyp incidence and specialized training needs.
Purpose of the Study:
- To evaluate the safety and efficacy of EMR in pediatric patients.
- To review pediatric EMR cases at two tertiary referral centers.
Main Methods:
- Retrospective chart review of pediatric EMR cases (patients <18 years).
- Data collected from January 2012 to May 2021 at two major medical centers.
- Included demographic, clinical, technical, and follow-up data.
Main Results:
- Fifteen EMR procedures were performed on 11 pediatric patients.
- Indications included rectal bleeding; polyp sizes ranged from 9-60mm.
- High technical success (93%) and clinical success (100%) with zero adverse events.
Conclusions:
- Pediatric EMR is a safe and effective procedure with high success rates.
- EMR should be performed at centers with experienced endoscopists specializing in pediatric EMR.
Objectives:
Endoscopic mucosal resection (EMR) for removal of large polyps is well established in adults. EMR technique in the pediatric population is less utilized due to lower incidence of large intestinal polyps in pediatric patients and limited EMR training for pediatric gastroenterologists. The aim of this study is to retrospectively review safety and efficacy of pediatric EMR cases at two large, tertiary referral centers with adult and pediatric EMR expertise.
Methods:
A retrospective chart review was conducted at Cedars-Sinai Medical Center and Cincinnati Children's Hospital Medical Center from January 2012 to May 2021. Demographic, clinical, technical and follow up data were collected for patients <18 years of age who underwent EMR during the study period.
Results:
Fifteen pediatric EMR procedures were identified in 11 patients (five male, six female) during the study period. Indication was most frequently rectal bleeding. Polyp size removed ranged from 9 to 60 mm and pathology was consistent with juvenile inflammatory polyps in six patients. Technical success was achieved in 14 of 15 (93%) of EMRs with clinical success (desired clinical outcome) in all 13 procedures with clinical follow-up. There were no adverse events.
Conclusions:
This study identifies a case series of pediatric patients who underwent EMR at two tertiary care centers. This series demonstrates successful EMR in children and shows a high technical and clinical success rate with a low complication rate. More investigation into EMR in pediatric patients is necessary, and its use should be isolated to centers with endoscopists with specific experience in EMR techniques.
