Pediatric Advanced Endoscopic Procedures

Advanced endoscopy includes the following therapeutic procedures for the diagnosis and treatment of several conditions:

Esophagogastroduodenoscopy (EGD)
Endoscopic retrograde cholangiopancreatography (ERCP)
Endoscopic ultrasound (EUS)
Endoscopic ultrasound fine needle aspiration (EUS-FNA)

What is esophagogastroduodenoscopy (EGD)?

Esophagogastroduodenoscopy is an outpatient diagnostic procedure that uses endoscopy to examine the esophagus, stomach, and duodenum.

What is endoscopic retrograde cholangiopancreatography (ERCP)?

Endoscopic retrograde cholangiopancreatography is an endoscopic procedure used to diagnose and treat a disease in either the bile duct or the pancreatic duct. In the bile duct, ERCP is used to remove stones and to bypass obstructions (such as the narrowing of a duct due to inflammation, tumor, or infection). ERCP can also be used to get biopsies or to treat strictures or infections (such as cholangitis), or to repair leaks after surgery or trauma. In the pancreatic duct, ERCP can be used to remove stones, treat strictures and infections, and drain fluid.

Endoscopic retrograde cholangiopancreatography is usually an outpatient procedure conducted under anesthesia. The endoscope is guided into the mouth, down the esophagus, through the stomach, and into the duodenum. The gastroenterologist locates the major papilla (a rounded projection at the opening of the common bile duct), where both the pancreatic and biliary ducts enter the duodenum. A guide wire and catheter are inserted through the major papilla and into one of the ducts. Using fluoroscopy, dye is injected so that the doctor can see on the x-ray the cause of blockage or other problems and then deliver the appropriate treatment.

Both endoscopic ultrasound (EUS) and ERCP allow doctors to conduct minimally invasive procedures and in many cases to avoid more invasive surgery, reducing recovery times, minimizing complications, and improving outcomes.

What is enteroscopy?

Enteroscopy is a procedure that uses an extraordinarily long endoscope, assisted by inflatable balloons, that can move deep into the small bowel, beyond the reach of ordinary endoscopes.

What is endoscopic ultrasound (EUS)?

The tips of some endoscopes are equipped with high-frequency-sound-wave imaging technology, called ultrasound, that can “see” through neighboring tissue. The use of these devices is called echo-endoscopy. These special endoscopes can be guided with their optical cameras, but they also can get detailed ultrasound images of the pancreas and other nearby abdominal organs. The high resolution of EUS images allows physicians to see structures or lesions (as small as 2 to 3 millimeters) that are sometimes missed by CT or MRI.

What is endoscopic ultrasound fine needle aspiration (EUS-FNA)?

Endoscopic ultrasound can be used to treat as well as diagnose. For example, endoscopic ultrasound fine needle aspiration (EUS-FNA) uses continuous endoscopic ultrasound monitoring to move an endoscope into position and then to guide a needle, which is extended out of the endoscope, into the pancreas, lymph nodes, fluid collections, masses, or infections. Once there, the needle can retrieve a biopsy for diagnosis, or it can treat disorders like pancreatic fluid collections, infectious cysts, or congenital cysts. Endoscopic ultrasound fine needle aspiration can also be used to repair leaks in the bile duct or the pancreatic duct.