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ERCP in children: Technique, success and complications

Moises Guelrud, MD
Section Editors
Melvin B Heyman, MD, MPH
Douglas A Howell, MD, FASGE, FACG
Deputy Editor
Alison G Hoppin, MD


Experience with endoscopic retrograde cholangiopancreatography (ERCP) in children has been limited due to multiple factors, including the relatively low incidence of diseases requiring ERCP in this age group, the impression that the procedure is technically difficult in children, and because the indications and safety of ERCP in children have not been well defined. As a result, patients are generally referred to a tertiary care facility or to adult endoscopists who perform a high volume of procedures.

This topic review will focus on the technical aspects of performing ERCP in children. Indications for ERCP in children are discussed separately. (See "ERCP for biliary disease in children" and "ERCP for pancreatic disease in children".)


Because most ERCP procedures in children are performed by adult gastroenterologists, a close working collaboration between an adult and a pediatric gastroenterologist is important during patient preparation and the procedure itself. The preparation and sedation of a child undergoing ERCP is similar to that used for upper gastrointestinal endoscopy. The procedure should be explained to the child in a manner appropriate for the age and level of intellectual and emotional development.

The endoscopist must choose between conscious sedation and general anesthesia after considering the pertinent risks and taking into account personal skill and experience and the expected complexity of the procedure. A state of deep sedation from which the patient is not easily aroused is often required, since young children and some adolescents cannot fully cooperate with procedures under lesser degrees of conscious sedation. Most children can be sedated adequately with a combination of meperidine or fentanyl and diazepam or midazolam. Children frequently require much higher doses of midazolam on a milligram per kilogram basis than adults. In occasions, children can also be sedated with propofol with anesthesia support.

Postprocedure monitoring is the same as for other endoscopic procedures requiring sedation. Personnel with appropriate training in pediatric sedation and monitoring are required for either conscious sedation or general anesthesia.


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Literature review current through: Sep 2016. | This topic last updated: Apr 13, 2016.
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  1. Guelrud M, Jaen D, Torres P, et al. Endoscopic cholangiopancreatography in the infant: evaluation of a new prototype pediatric duodenoscope. Gastrointest Endosc 1987; 33:4.
  2. Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy. Radiographic contrast media used in ERCP. May 1995.
  3. Dua K, Miranda A, Santharam R, et al. ERCP in the evaluation of abdominal pain in children. Gastrointest Endosc 2008; 68:1081.
  4. Cotton PB, Laage NJ. Endoscopic retrograde cholangiopancreatography in children. Arch Dis Child 1982; 57:131.
  5. Kunitomo K, Ming L, Urakami Y, et al. Endoscopic retrograde cholangiopancreatography in pediatric surgical biliary diseases. Tokushima J Exp Med 1988; 35:57.
  6. Buckley A, Connon JJ. The role of ERCP in children and adolescents. Gastrointest Endosc 1990; 36:369.
  7. Putnam PE, Kocoshis SA, Orenstein SR, Schade RR. Pediatric endoscopic retrograde cholangiopancreatography. Am J Gastroenterol 1991; 86:824.
  8. Guelrud M, Mendoza S, Jaen D, et al. ERCP and endoscopic sphincterotomy in infants and children with jaundice due to common bile duct stones. Gastrointest Endosc 1992; 38:450.
  9. Dítè P, Vacek E, Stefan H, et al. Endoscopic retrograde cholangiopancreatography in childhood. Hepatogastroenterology 1992; 39:291.
  10. Brown CW, Werlin SL, Geenen JE, Schmalz M. The diagnostic and therapeutic role of endoscopic retrograde cholangiopancreatography in children. J Pediatr Gastroenterol Nutr 1993; 17:19.
  11. Guelrud M, Mujica C, Jaen D, et al. The role of ERCP in the diagnosis and treatment of idiopathic recurrent pancreatitis in children and adolescents. Gastrointest Endosc 1994; 40:428.
  12. Brown KO, Goldschmiedt M. Endoscopic therapy of biliary and pancreatic disorders in children. Endoscopy 1994; 26:719.
  13. Tagge EP, Tarnasky PR, Chandler J, et al. Multidisciplinary approach to the treatment of pediatric pancreaticobiliary disorders. J Pediatr Surg 1997; 32:158.
  14. Graham KS, Ingram JD, Steinberg SE, Narkewicz MR. ERCP in the management of pediatric pancreatitis. Gastrointest Endosc 1998; 47:492.
  15. Güitrón A, Adalid R, Barinagarrementería R, et al. [Endoscopic cholangiopancreatography (ERCP) in pediatric patients]. Rev Gastroenterol Mex 1998; 63:211.
  16. Hsu RK, Draganov P, Leung JW, et al. Therapeutic ERCP in the management of pancreatitis in children. Gastrointest Endosc 2000; 51:396.
  17. Reinshagen K, Müldner A, Manegold B, Kähler G. Efficacy of ERCP in infancy and childhood. Klin Padiatr 2007; 219:271.
  18. Rocca R, Castellino F, Daperno M, et al. Therapeutic ERCP in paediatric patients. Dig Liver Dis 2005; 37:357.
  19. Jang JY, Yoon CH, Kim KM. Endoscopic retrograde cholangiopancreatography in pancreatic and biliary tract disease in Korean children. World J Gastroenterol 2010; 16:490.
  20. Otto AK, Neal MD, Slivka AN, Kane TD. An appraisal of endoscopic retrograde cholangiopancreatography (ERCP) for pancreaticobiliary disease in children: our institutional experience in 231 cases. Surg Endosc 2011; 25:2536.
  21. Guelrud M, Carr-Locke D, Fox VL. ERCP in Pediatric Practice: Diagnosis and Treatment. Oxford, UK: Isis Medical Media Ltd, 1997.
  22. Heyman MB, Shapiro HA, Thaler MM. Endoscopic retrograde cholangiography in the diagnosis of biliary malformations in infants. Gastrointest Endosc 1988; 34:449.
  23. Guelrud M, Jaen D, Mendoza S, et al. ERCP in the diagnosis of extrahepatic biliary atresia. Gastrointest Endosc 1991; 37:522.
  24. Wilkinson ML, Mieli-Vergani G, Ball C, et al. Endoscopic retrograde cholangiopancreatography in infantile cholestasis. Arch Dis Child 1991; 66:121.
  25. Derkx HH, Huibregtse K, Taminiau JA. The role of endoscopic retrograde cholangiopancreatography in cholestatic infants. Endoscopy 1994; 26:724.
  26. Mitchell SA, Wilkinson ML. The role of ERCP in the diagnosis of neonatal conjugated hyperbilirubinemia (abstract). Gastrointest Endosc 1994; 40:A55.
  27. Ohnuma N, Takahashi T, Tanabe M, et al. The role of ERCP in biliary atresia. Gastrointest Endosc 1997; 45:365.
  28. Iinuma Y, Narisawa R, Iwafuchi M, et al. The role of endoscopic retrograde cholangiopancreatography in infants with cholestasis. J Pediatr Surg 2000; 35:545.
  29. Varadarajulu S, Wilcox CM, Hawes RH, Cotton PB. Technical outcomes and complications of ERCP in children. Gastrointest Endosc 2004; 60:367.
  30. Cheng CL, Fogel EL, Sherman S, et al. Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography in children: a large series report. J Pediatr Gastroenterol Nutr 2005; 41:445.
  31. Vegting IL, Tabbers MM, Taminiau JA, et al. Is endoscopic retrograde cholangiopancreatography valuable and safe in children of all ages? J Pediatr Gastroenterol Nutr 2009; 48:66.
  32. Giefer MJ, Kozarek RA. Technical outcomes and complications of pediatric ERCP. Surg Endosc 2015; 29:3543.
  33. Iqbal CW, Baron TH, Moir CR, Ishitani MB. Post-ERCP pancreatitis in pediatric patients. J Pediatr Gastroenterol Nutr 2009; 49:430.
  34. Troendle DM, Abraham O, Huang R, Barth BA. Factors associated with post-ERCP pancreatitis and the effect of pancreatic duct stenting in a pediatric population. Gastrointest Endosc 2015; 81:1408.