Examination of the pancreas and biliary and digestive structures by endoscopic ultrasonography (EUS) can be tricky and using it to make a diagnosis can be challenging. Understanding anatomical variations and postoperative modifications is vital when undertaking EUS, as is choosing the correct linear echoendoscope for the structures being examined (e.g. the hilum of the liver versus the tail of the pancreas). There can also be difficulties with tissue acquisition related to tumour location and internal structures, and there are situations when sampling is contraindicated. Consideration also needs to be given to the use of contrast with special settings and difficulties in differential diagnosis (pancreatic solid lesions, indeterminate biliary strictures, gastric neuroendocrine tumours). The role of EUS assessment after neoadjuvant therapy should also be considered. Here we discuss the most frequent mistakes that are made in pancreatobiliary and digestive EUS imaging. 

Cholangioscopy is a minimally invasive, endoscopic technique that allows direct visualisation of the bile ducts, facilitating both diagnostic and therapeutic interventions. It is a useful tool in managing biliary diseases, allowing characterisation and tissue acquisition for strictures of undetermined aetiology, facilitating extension assessment for biliary cancer and providing intraductal lithotripsy for complex biliary stones.

Adequate nutrition is essential for the homeostasis of fluids and nutrients, growth and thriving, especially in children. While the underlying principle of percutaneous endoscopic gastrostomy (PEG) placement is the same for both adults and children—providing a means of enteral feeding through the stomach—the indications, considerations and techniques differ owing to anatomical differences, age-dependent physiological concerns, and the age- and disease-specific needs of the child.

If feeding via nasogastric tube (NGT) or naso-jejunal tube (NJT) is necessary for a prolonged time, placement of a PEG or percutaneous endoscopic gastro-jejunal (PEG-J) tube should be considered. A PEG tube also allows the delivery of medications and venting of the stomach when needed. Nutrition via PEG facilitates the transition to out-of-hospital care and improves the quality of life (QoL) for children and families while improving the outcome of children with chronic diseases.

There are recent clinical guidelines providing guidance for PEG tube placement in children, but little advice on, e.g., choosing the right device for the right patient, details on postoperative management, removal of the PEG tube and other specific cases. The following article provides a combination of evidence-based data and the authors’ clinical experience.