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Objective To explore the clinical value and safety of enhanced recovery after surgery ( ERAS) plus colonoscopy for colorectal polypi in children. Methods Clinical data were retrospectively reviewed for 200 children undergoing endoscopic resection of colorectal polypi. They were randomized into two groups of ERAS plus colonoscopic polypectomy ( n = 100 ) and conventional perioperative management plus colonoscopic polypectomy ( n = 100) . Perioperative treatment, clinical symptoms, surgical parameters, biochemical indices and postoperative adverse reactions were recorded. Results Operative duration of ERAS and control groups was [ ( 27. 77 ± 8. 76) vs. ( 33. 88 ± 6. 58) min], postoperative defecation time [ ( 1. 50 ± 0. 50) vs. ( 3. 50 ± 1. 00) days] and hospitalization duration [ ( 3. 00 ± 1. 00) vs. ( 6. 00 ± 1. 00) days]. In ERAS children, blood glucose post-operation was significantly higher than that pre-operation[ 5. 75 (5. 15, 6. 08) vs. 5. 10 ( 4. 80, 5. 90), z = - 3. 807, P < 0. 001], blood insulin spiked significantly post-operation[ 16. 30 ( 15. 70, 16. 90) vs. 7. 55(6. 30,9. 05), z = - 8. 682,P < 0. 001], insulin resistance index post-operation was significantly higher than that pre-operation[ 4. 07 (3. 77, 4. 34) vs. 1. 72( 1. 46,2. 02), z = - 8. 682, P < 0. 001], blood glucose post-operation in control group was significantly higher than that in ERAS group [ 9. 60 ( 8. 90, 10. 80) vs. 5. 75(5.15, 6. 08), U =21. 000, P <0. 001], blood insulin was significantly higher in control group than that in ERAS group[22. 80(21. 73, 23. 68) vs. 16. 30( 15. 70, 16. 90), P <0. 001] and insulin resistance index was significantly higher in control group than that in ERAS group[9. 77(8. 89,10. 77) vs. 4. 07(3. 77, 4. 34), P < 0. 001]. Two group are no aspiration during operation and abdominal pain was ( 6 vs. 21), diarrhea ( 4 vs. 5), vomiting ( 5 vs. 24) and dizziness ( 23 vs. 5) . VAS was significantly higher in control group than that in ERAS group[ (6. 00 ± 1. 00) vs. (3.50 ± 1. 00), X² =38. 000,P <0.001]. Conclusion After colonoscopy for colorectal polypi, ERAS can accelerate the rehabilitation and lower postoperative complications in children. It is both safe and feasible in the management of endoscopic smgery. [ABSTRACT FROM AUTHOR]