Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography Procedures

Advanced endoscopy plays an important role in the diagnosis and management of complex gastrointestinal disease in children. Yet nationwide, there is limited access to pediatric-trained physicians with expertise in interventional procedures such as endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS). ERCP is used to diagnose and treat disorders of the bile ducts and pancreas. EUS combines endoscopy with ultrasound imaging to evaluate gastrointestinal, pancreatic and other abdominal structures. Until recently, many children in Wisconsin who required these procedures had to seek care at an adult hospital or leave the state, often facing delays and added strain on families.

In October 2024, our team at Children’s Wisconsin launched the Advanced and Interventional Endoscopy Program to bring this level of care closer to home. The program grew out of specialized interventional training completed by Diana Lerner, MD, at the University of Colorado Anschutz Medical Center. Fewer than 20 pediatric gastroenterologists nationally have formal training in both ERCP and EUS, a reality that has long constrained access to these procedures in pediatric settings. By establishing our Advanced and Interventional Endoscopy Program, we expanded our clinical reach and strengthened continuity for patients and referring providers.

For many pediatric gastroenterology teams, advanced endoscopy has reshaped how we manage a wide range of complex gastrointestinal conditions. Through ERCP, we now treat biliary and pancreatic disorders such as choledocholithiasis, biliary strictures and select causes of pancreatitis without defaulting to surgical intervention. Meanwhile, EUS offers high-resolution imaging of the pancreas, biliary tree and surrounding structures and is helpful in targeted tissue sampling when clinical questions demand greater precision. Together, these tools shift decision-making earlier in the care pathway and reduce reliance on more invasive approaches.

Keeping advanced endoscopy within our pediatric system has also changed the experience for patients and families. Rather than navigating transfers to adult-focused or out-of-state centers, children now receive evaluation, intervention and follow-up care in a familiar and pediatric-focused environment. Referring physicians can also benefit from tighter communication loops and more predictable care timelines, particularly when managing children with evolving or complex gastrointestinal disease.

Deepening Collaboration Across Children’s Wisconsin

Advanced endoscopy frequently sits at the intersection of diagnosis and definitive treatment, fostering shared planning discussions involving experts in numerous specialties, including:

• Anesthesia 

• Hepatology 

• Oncology

• Pancreatology 

• Pathology 

• Radiology 

• Surgery

• Transplant 

We now design care plans collaboratively, aligning imaging, endoscopic intervention and surgical decision-making to reduce fragmentation and improve efficiency.

In many cases, this coordination supports combining procedures under a single anesthetic. For children with medical complexity or those who require multiple interventions, minimizing repeated anesthetic exposures matters. Achieving this coordination requires deliberate scheduling, early communication and shared ownership across teams. This reduces procedural and financial burdens for families and reinforces a system-wide commitment to coordinated care.

Although the program remains in the early stages of development, we have already seen a tangible operational impact. Timely access to advanced diagnostic and therapeutic options has reduced delays and improved efficiency. Families frequently express relief at staying within our system for care that previously required travel. Referring physicians describe stronger collaboration and clearer pathways for escalation when advanced intervention becomes necessary. And as procedural volume grows, we plan to track outcomes, utilization and downstream effects on surgical care to better understand long-term impact.

It’s important to understand that pediatric anatomy and disease presentation differ fundamentally from adult practice, and procedural risk requires thoughtful case selection and technical expertise. By investing in formal interventional training and building a dedicated program, we created a structure that provides the institutional support needed to enhance safety and effectiveness.

Looking ahead, we plan to continue expanding our Advanced and Interventional Endoscopy Program while strengthening regional collaboration. As experience grows, we see opportunities to develop clearer care pathways, intervene earlier in disease progression and further reduce the need for invasive surgery.

By building interventional endoscopy capability within pediatric gastroenterology, we have expanded what is possible for children with complex gastrointestinal disease at Children’s Wisconsin.