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ERCP for pancreatic disease in children

Moises Guelrud, MD
Section Editors
Melvin B Heyman, MD, MPH
Douglas A Howell, MD, FASGE, FACG
Deputy Editor
Alison G Hoppin, MD


Endoscopic retrograde cholangiopancreatography (ERCP) has changed the approach to the diagnosis and management of pancreatic disorders in adults. It remains a less common procedure in children despite accumulating experience since the mid-1980s in the use of ERCP for a variety of indications.

The pancreatic disorders that can be evaluated by ERCP are described here. The use of ERCP for biliary disorders in children and the technique, success, and complications of ERCP in children are discussed separately. (See "ERCP for biliary disease in children" and "ERCP in children: Technique, success and complications".)


Endoscopic retrograde cholangiopancreatography (ERCP) should be considered for all patients with pancreatitis for which an anatomical cause is suspected. Potential indications for ERCP in children with pancreatitis are listed in the table (table 1) [1].

Initial evaluation — Prior to considering ERCP, specific non-anatomical causes of pancreatitis should be explored. These include infections, systemic diseases (including inflammatory conditions and cystic fibrosis), drug-induced pancreatitis, and blunt trauma to the pancreas. In recurrent or chronic pancreatitis, hereditary causes should be explored through genetic screens for cationic trypsinogen (PRSS1), SPINK 1, cystic fibrosis transmembrane conductance regulator (CFTR) and chymotrypsinogen C (CTRC) mutations [2]. (See "Clinical manifestations and diagnosis of chronic pancreatitis in children" and "Hereditary pancreatitis", section on 'Genetic testing' and "Causes and contributing risk factors for chronic pancreatitis in children and adolescents", section on 'Genetic'.)

Imaging with abdominal computerized tomography (CT) or magnetic resonance cholangiopancreatography (MRCP) is important to establish the extent of the pancreatitis. Some experts suggest MRCP prior to consideration of ERCP for most patients with chronic or recurrent pancreatitis because ERCP is more invasive and the procedure may trigger or exacerbate the pancreatitis. Others have suggested endoscopic ultrasound (EUS) which is particularly useful for diagnosing gallbladder sludge, pancreas divisum, congenital biliary anomalies, duodenal duplication cyst, and chronic pancreatitis [3]. On the other hand, ERCP has the advantage of offering therapeutic interventions, such as sphincterotomy and stent placement. Therefore, ERCP is appropriate for patients in whom a treatable anatomic anomaly has been identified or is strongly suspected. (See "Clinical manifestations and diagnosis of chronic pancreatitis in children".)


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Literature review current through: Sep 2016. | This topic last updated: Oct 6, 2015.
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