Department of Internal Medicine, Karsh Division of Gastroenterology and Hepatology, Cedars Sinai Medical Center, Los Angeles, CA.
Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH.
J Pediatr Gastroenterol Nutr. 2022 Jan 1;74(1):20-24. doi: 10.1097/MPG.0000000000003275.
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.
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.
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.
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.
内镜黏膜切除术（EMR）用于切除大型息肉在成人中已得到广泛应用。由于儿科患者大肠息肉的发病率较低，且儿科胃肠病学家对 EMR 的培训有限，因此在儿科人群中较少应用 EMR 技术。本研究的目的是回顾性分析两家大型三级转诊中心具有成人和儿科 EMR 专业知识的儿科 EMR 病例的安全性和有效性。
对 Cedars-Sinai 医疗中心和辛辛那提儿童医院医疗中心 2012 年 1 月至 2021 年 5 月期间的病历进行回顾性分析。收集了研究期间接受 EMR 的年龄<18 岁的患者的人口统计学、临床、技术和随访数据。
在研究期间，共在 11 名患者（5 名男性，6 名女性）中发现了 15 例儿科 EMR 手术。主要适应证为直肠出血。切除的息肉大小为 9-60mm，其中 6 例病理检查符合青少年炎性息肉。15 例 EMR 中有 14 例（93%）获得技术成功，13 例有临床随访的 EMR 均获得临床成功（期望的临床结局）。无不良事件发生。
本研究确定了在两家三级护理中心接受 EMR 的儿科患者的病例系列。本研究表明 EMR 可在儿童中安全进行，并显示出高的技术和临床成功率，并发症发生率低。需要对儿科患者的 EMR 进行更多的研究，并且应将其仅应用于具有 EMR 技术特定经验的内镜医生的中心。
