A team of highly trained and experienced staff perform complex imaging and interventional endoscopic procedures on children with pancreatic disorders at Children’s Hospital of Philadelphia (CHOP). The bedrock to many of these procedures is endoscopy, a minimally invasive way for doctors to see inside your child’s body and get close to the pancreas.

Our team is trained in the full range of endoscopic procedures used to diagnose – and in some cases, treat – pancreatic disorders.  

The pancreas is a gland in the upper part of the abdomen, found behind the stomach and near the intestines. It is part of the digestive system and releases important hormones such as insulin that regulate blood sugar and the enzymes that digest food. When your child’s pancreas is not working properly, it can cause a range of diseases including pancreatitis, pancreatic cancer, diabetes and others.  

Benefits of an endoscopic approach to pancreatic diseases

Endoscopic imaging allows the clinical team to get a close and detailed look at your child’s pancreas without the need for surgery. After your child is sedated, a long, flexible tube with a camera on the end is guided through your child’s mouth, into the esophagus, then to the stomach and finally into the first part of the small intestine – which is directly next to the pancreas. From that location, the clinician can perform imaging tests such as ultrasound or X-rays, collect tissue samples and fix many of the problems they may find.  

Using endoscopy to collect tissue samples from your child’s pancreas and treat complications from pancreatitis does not require any cuts on their skin, meaning your child will experience less pain and scarring than surgical treatment, and typically have a shorter recovery period.  

The following advanced pancreatic endoscopic approaches are available to children being treated in the Pancreatic Disorders Program at CHOP: 

• Endoscopic retrograde cholangiopancreatography
• Endoscopic ultrasound
• Cystogastrostomy
• Endoscopic pancreatic function testing 

Endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) combines upper gastrointestinal endoscopy and X-rays to find, diagnose and treat problems in the bile ducts and pancreatic ducts.  

During ERCP, a gastroenterologist or professional endoscopist injects a contrast agent into the ducts of your child’s bile or pancreas to take detailed imaging to determine if there are any abnormalities. They are looking for compressed areas (kinks), unnatural narrowing and stones that can cause problems. If a problem is discovered, specialized tools may be used during the procedure to fix the problem.  

CHOP was one of the first centers in the country to have a pediatric-trained therapeutic endoscopist on staff to perform ERCPs and is one of a few centers to have multiple physicians trained in pediatric ERCP.   

Endoscopic ultrasound

Endoscopic ultrasound (EUS) is a special type of endoscopy that uses an ultrasound in addition to the endoscopy camera. This ultrasound is more detailed than a typical ultrasound in which imaging is performed outside the body. With an endoscopic ultrasound, clinicians can get much closer to your child’s pancreas without skin, muscle and other organs in the way.  

During EUS, the endoscopist can also use a needle to collect a sample of your child’s pancreatic tissue – known as a biopsy – for pathologists to examine under a microscope. These samples can help clinicians diagnose rare cancers and rare causes of pancreatitis without the need for surgery.   

Cystogastrostomy

A cystogastrostomy is an endoscopic procedure performed to drain a pancreatic pseudocyst, an abnormal fluid collection in or around the pancreas that can occur due to acute or chronic pancreatitis. This procedure is performed using an endoscope, a thin, flexible tube with a camera and special instruments, that is inserted through the mouth and into the GI tract. During a cystogastrostomy, a stent or small tube is placed to allow the fluid to drain safely into the stomach. 

Endoscopic pancreatic function testing

An endoscopic pancreatic function test (also called a pancreatic stimulation test), is used to measure the digestive enzymes made by your child’s pancreas. While your child is sedated, the clinical team gives your child hormones – that the body makes naturally – through an IV to stimulate the pancreas. An endoscopist will then measure how well your child’s pancreas responds to the hormones and diagnose any abnormalities.   

CHOP leaders have been involved in developing national and international protocols for endoscopic pancreatic function testing.    

Why choose CHOP for advanced pancreatic endoscopy?

A global pioneer in a wide range of approaches to improve the care of children with pancreatic disorders, staff in the Pancreatic Disease Program at Children’s Hospital of Philadelphia (CHOP) offer the most innovative and comprehensive care for children with pancreatic conditions. 

Our program is one of the busiest pediatric pancreatic surgical centers in the country, offering a pancreas-focused multidisciplinary team, advanced diagnostic and surgical procedures, quick scheduling of appointments and dedicated nurse coordinators to help your family at every step.

Our team of experts includes world leaders in pancreatic diseases who are constantly looking to improve care, find new treatment options and improve outcomes. We are also actively involved in clinical research, safety and quality improvement programs.