Endoscopic retrograde cholangiopancreatography in pediatrics

Endoscopic retrograde cholangiopancreatography (ERCP) is a useful, although understudied, tool in the diagnosis and treatment of pancreaticobiliary disease in pediatric populations. Although appropriately sized equipment is somewhat limited, 7.5-mm duodenoscopes are available and can be used in even the smallest infants along with a small array of devices to fit through the 2.0-mm channel. Indications for ERCP in children are similar to those in adults and include therapy of biliary and pancreatic ductal obstruction or disruption, although the etiologies of the obstructions may differ greatly between the 2 populations. Rates of complications and procedural success are similar in pediatric and adult patients. Historically, most pediatric ERCPs have been performed by experienced adult endoscopists, but during the past 15 years, there has been increased interest in pursuing therapeutic endoscopy training among pediatric gastroenterologists. Prospective multicentered studies at pediatric centers will help define the role of pediatric ERCP in the treatment of children with pancreatic and biliary disease.