Endoscopic devices are being used to treat gastrointestinal disorders in adults but not as much in pediatric patients—a practice Johns Hopkins Children’s Center aims to change.

Endoscopic retrograde cholangiopancreatography (ERCP) is commonly used in treating biliary and pancreatic disorders for adults but rarely for children, partly because the technology is expensive and the volume of pediatric patients is much lower. Pediatric gastroenterologist Kenneth Ng, D.O., is leading efforts at Johns Hopkins Children’s Center to change that practice and improve care for children with conditions such as stone disease, strictures, and obstruction of the biliary or pancreatic ducts.

“In the adult world, many centers have the expertise to use this technology, but in the pediatric world, it’s actually quite rare,” says Ng. “I feel it’s very important to bring that expertise to our pediatric patients.”

In ERCP, Ng explains, an index-finger-thick side-viewing scope called a duodenoscope is placed through the mouth and into the stomach and the first part of the small intestine. There, in the duodenum, endoscopic tools are carefully passed through the ampulla (doorway) into either the common bile duct or pancreatic duct to treat diseases of these ducts. As part of the procedure, contrast is injected into the duct of interest and X-rays are taken to map it out. While traditional endoscopes with a forward-viewing camera have generally played a diagnostic role, ERCP’s unique side-viewing cameras are designed to access the intersection of the biliary and pancreatic ducts for treatment purposes as well.

“Essentially, ERCP is a technique that uses a unique side-viewing duodenoscope to both diagnose and treat diseases of the biliary and pancreatic ducts—essentially, you’re driving sideways,” says Ng, who recently attended an eight-week intensive ERCP training course in Mumbai, India.

Ng is also introducing other new tech tools to the pediatric gastrointestinal (GI) endoscopy program, including Hemospray to improve bleeding control, and EndoFLIP, a balloon-catheter system designed to detect GI narrowing and screen for abnormal movement.

“It’s kind of a fancy ruler,” says Ng, “that allows us to know the before and after of our therapeutic actions, and in turn can help optimize care.”

PUBLISHED IN SPRING 2019 PEDIATRICIAN