27 - ERCP and EUS in children

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) was introduced into pediatric medicine in the late 1970s and is now routinely used for the diagnosis and treatment of biliary tract and pancreatic diseases in children throughout the world. Similar to practice in adults, ERCP in children is now predominantly used for anticipated therapeutic interventions. Recent pediatric reports have focused on technical success, safety, and therapeutic efficacy. In high-volume tertiary pediatric referral centers, ERCP is increasingly performed by expert pediatric endoscopists working independently. General anesthesia with endotracheal intubation is commonly employed. Fluoroscopy equipment should be adjusted to reduce the radiation dose to a smaller body with greater vulnerability to radiation injury. Because no endoscopic equipment is specifically designed for pediatric practice, even simple maneuvers can be technically challenging in infants and very young children. High rates of technical success and low rates of adverse events appear equivalent to adult patients. This chapter highlights unique aspects of pediatric ERCP, distinguished by differences in childhood behavior, physiology, anatomy, and disease spectrum compared with adults. Endoscopic ultrasound (EUS) is now used with increasing frequency alone and in combination with ERCP to reduce the need for surgery in the management of complicated biliary and pancreatic disease in children. EUS-guided drainage of pancreatic fluid collections and EUS-guided fine-needle biopsy (FNB) of pancreatic tumors have become the same standard of care in pediatrics, just as they are in adult practice. EUS in children will likely continue to expand as advanced pediatric endoscopists find opportunities to train and apply this technology more broadly.