Endoscopic retrograde cholangiopancreatography (ERCP) in infants (younger than 1 year of age) is a highly specialized procedure. Since 2014 opportunities to maintain or purchase duodenoscopes for ERCP in infants have disappeared. In a survey among European hepatology centers (including Israel) we evaluated the availability, need, indications, and practice of ERCP procedures in infants. It shows that infant ERCP is a low-volume procedure (median 5 procedures/year) in the 14 centers that perform this procedure. Since 2014 several centers no longer have an infant ERCP duodenoscope due to breakdown. In addition, substantial differences exist between centers in indications, types of interventions performed, and practical execution of ERCP procedures in infants. We conclude that a concerted effort by the pediatric hepatology community is needed to secure the future availability of infant ERCP. In addition, consensus on the indications and optimal use of infant ERCP could improve the quality of ERCP care for infants.

Department of Gastroenterology and Hepatology Amsterdam University Medical Centre Amsterdam Gastroenterology and Metabolism Amsterdam The Netherlands

Department of Internal Medicine Charles University 2nd Faculty of Medicine University Hospital Motol Prague Czech Republic

Department of Paediatric Kidney Liver and Metabolic Diseases Division of Paediatric Gastroenterology and Hepatology Hannover Medical School Hannover Germany

Department of Pediatric Gastroenterology Emma Children's Hospital Amsterdam University Medical Centre Amsterdam The Netherlands

Department of Pediatric Surgery King's College Hospital London United Kingdom

Inserm U1174 Hepatinov University of Paris Sud Paris Saclay Orsay France

Liver Unit Birmingham Women's and Children's Hospital Institute of Immunology and Immunotherapy University of Birmingham Birmingham

Paediatric Centre for Hepatology Gastroenterology and Nutrition King's College Hospital London UK

Paediatric Hepatology and Liver Transplantation Unit National Reference Centre for Biliary Atresia Bicêtre Hospital Assistance Publique Hôpitaux de Paris University of Paris Sud Paris Saclay Le Kremlin Bicêtre

Service of Pediatric Hepatology Hospital Infantil Universitario La Paz Madrid Spain

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