Pediatric endoscopic mucosal resection: A 10-year single-center experience

Abstract

Objectives: Endoscopic mucosal resection (EMR) is well established in adult gastroenterology but remains underutilized in pediatrics due to limited data, training opportunities, and equipment. This study presents a 10-year, single-center experience with conventional hot and cold snare EMR, band-assisted (B-EMR), and underwater EMR (U-EMR) techniques in pediatric patients. Methods: A retrospective review was conducted of all EMR procedures performed in patients under 21 years of age between 2015 and 2025 at a tertiary care children's hospital. Data on patient demographics, lesion characteristics, procedural details, pathology, and outcomes were collected and analyzed descriptively. Results: Twenty EMRs were performed in 18 patients (mean age 17.1 years, range 3-20). The most common underlying diagnoses included familial adenomatous polyposis (n = 7), sporadic mucosal polyps (n = 4), subepithelial lesions (n = 4), juvenile polyposis syndrome (n = 2), Peutz-Jeghers syndrome (n = 1), and Lynch syndrome (n = 1). Lesions ranged from 6 to 80 mm and were located throughout the gastrointestinal tract, most commonly in the colon (n = 9), duodenum (n = 5), and esophagus (n = 3). Techniques included hot snare EMR (n = 9), cold snare EMR (n = 6), B-EMR (n = 4), and U-EMR (n = 1). Complete resection was achieved in 95% of cases, with one incomplete resection requiring surgical management for adenocarcinoma. B-EMR was safely applied to subepithelial lesions. No delayed complications occurred. Conclusions: EMR is feasible, safe, and effective in pediatric patients for both mucosal and subepithelial lesions. Broader adoption in pediatric practice will require expanded training, multidisciplinary collaboration, and development of pediatric-specific guidelines. These findings support EMR as a valuable therapeutic option in complex pediatric gastrointestinal disease.