ERCP for biliary disease in children
- Moises Guelrud, MD
Moises Guelrud, MD
- Clinical Professor of Medicine
- Tufts University School of Medicine
- Section Editors
- Elizabeth B Rand, MD
Elizabeth B Rand, MD
- Section Editor — Pediatric Hepatology
- Professor of Pediatrics
- University of Pennsylvania School of Medicine
- Douglas A Howell, MD, FASGE, FACG
Douglas A Howell, MD, FASGE, FACG
- Section Editor — EUS/ERCP
- Assistant Clinical Professor of Medicine, Tufts Medical School Director,
- Pancreaticobiliary Center Director, Advanced Interventional Endoscopy Fellowship, Maine Medical Center
- Melvin B Heyman, MD, MPH
Melvin B Heyman, MD, MPH
- Section Editor — Pediatric Gastroenterology
- Professor of Pediatrics
- University of California, San Francisco
Endoscopic retrograde cholangiopancreatography (ERCP) has an important role in the care of children with a variety of biliary tract disorders, which can be divided broadly as congenital or acquired (table 1). This topic review will summarize indications for ERCP in children with biliary diseases, focusing on some of the more common disorders. Most of these disorders are discussed in further detail in their corresponding topic reviews. The technical aspects of performing ERCP in children, including complications, and for the use of ERCP for pancreatic disorders, are presented separately. (See "ERCP in children: Technique, success and complications" and "ERCP for pancreatic disease in children".)
Endoscopic retrograde cholangiopancreatography (ERCP) is an important diagnostic and therapeutic tool for biliary disease in infants and children, as it is in adults. With the advent of new diagnostic imaging techniques such as magnetic resonance cholangiopancreatography (MRCP), ERCP is evolving into a predominantly therapeutic procedure. The usefulness and safety of ERCP in the pediatric age group depends in large part on the experience of the endoscopist. If the necessary experience and equipment are available at an institution, the following are appropriate biliary indications for ERCP:
●Neonatal cholestasis (for biliary cysts; and at some institutions as part of the evaluation for suspected biliary atresia)
●Investigation of inconclusive abnormal findings on other examinations (eg, MRCP or CT scan)
●Biliary obstruction (eg, due to known or suspected choledocholithiasis, bile plug syndrome, parasitic infestation, biliary strictures, or primary sclerosing cholangitis)
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- Diagnostic indications
- Therapeutic indications
- NEONATAL CHOLESTASIS
- Biliary atresia
- Alagille syndrome
- Caroli disease and congenital hepatic fibrosis
- BILIARY CYSTS
- Anomalous pancreaticobiliary junction
- Malignancy risk
- SCLEROSING CHOLANGITIS
- BILE PLUG SYNDROME
- MALIGNANT STRICTURES
- BILE DUCT COMPLICATIONS AFTER LIVER TRANSPLANTATION
- HEPATOBILIARY TRAUMA