[Indications, findings and complications of ERCP in pediatrics]

Endoscopic retrograde cholangio-pancreatography presents the only method which not only produces exact results concerning the morphology of the pancreatic and biliary ducts but also enables therapeutic access to these structures. In childhood ERCP is indicated if other non invasive diagnostic procedures do not help to establish a diagnosis or if further informations concerning indication or planning of an operation can be expected. In 25 children and 13 adolescents ERCP established the correct diagnosis in 95%. The success rate in newborns after the second month reaches 90%. For children before the age of 2 months a pediatric duodenoscope with a diameter of 7-9 mm is necessary. In obstructive jaundice, after trauma of the upper abdomen and especially in pancreatitis of unknown origin ERCP should be performed liberally, because a lot of exploratory laparotomies can be prevented, and significant findings for operative intervention can be collected. Moreover the causes of pancreatitis can be evaluated and treated definitely. With EST impressive improvements in the clinical course of obstructive jaundice, cholangitis and acute pancreatitis even in children and adolescents can be reached. In our own series 9 children (3 acute biliary pancreatitis, 3 chronic obstructive pancreatitis, 1 acute pancreatitis, 2 biliary duct stones with cholangitis or ampullary stenosis) were treated successfully without any significant complications. In acute pancreatitis an ERCP should be performed as early as possible (during 24-48 hours after onset of symptoms) because only in this instance the etiologic factors can be evaluated reliably and using endoscopic sphincterotomy of the sphincter proprius choledochi and/or the sphincter proprius pancreatis be treated adequately and with the lowest risk in time.(ABSTRACT TRUNCATED AT 250 WORDS)