Endoscopic retrograde cholangiopancreatography in children.

In the past two decades, the possibility to visualize the biliary tree and the pancreatic duct using endoscopic retrograde cholangiopancreatography (ERCP) has substantially influenced evaluation and treatment of adult patients with suspected pancreaticobiliary disease. Development of pediatric duodenoscopes, expansion of indications for the procedure in children, and availability of newly skilled pediatric endoscopists have resulted in an increasing number of these procedures being performed in children. Operative endoscopic procedures are also applicable to children and adolescents; techniques such as endoscopic sphincterotomy, biliary drainage, common bile duct stone and pancreatic duct stone extraction, implantation of endoprosthesis, and pancreatic pseudocyst drainage are beginning to be used in children, with an overall success rate similar to that seen in adult patients. Techniques, indications, complications, and diagnostic and therapeutic applications of ERCP in the pediatric population are defined.