Endoscopic retrograde cholangiopancreatography (ERCP) in children with pancreatic diseases

Endoscopic retrograde cholangiopancreatography (ERCP) is nowadays a valuable method for detailed diagnostic evaluation and minimally invasive therapy for biliary and pancreatic diseases in pediatric population. The technique of ERCP is no more difficult in children than in adults, and except infants, there is no need for use a special pediatric endoscope. In children ERCP is usually performed with the patient under general anesthesia. Routine antibiotic prophylaxis is controversial, because there is no pediatric data regarding this problem. Pediatric indications for ERCP are similar to those for adults, though with a much lower incidence of malignant diseases. Among children with pancreatic diseases a common indications are: acute or recurrent acute pancreatitis, chronic pancreatitis, abdominal pain suspected to be of pancreaticobiliary origin, suspicion of pancreatic ductal anomaly, pancreatic trauma, differential diagnosis of focal pancreatic lesions and preoperative evaluation. Therapeutic ERCP constitutes 30-78% of all ERCPs and has a significant impact on the management of patients with pancreatic diseases, offering an alternative to surgical treatment in some cases. Pediatric studies demonstrates that ERCP has a high degree of technical success and a low rate of complications when performed by experienced endoscopists. MRCP nowadays has become the first-line diagnostic tool for biliopancreatic diseases and in the future ERCP may play a role mainly as a therapeutic intervention.