Surgical Endoscopy

, Volume 25, Issue 8, pp 2536–2540

An appraisal of endoscopic retrograde cholangiopancreatography (ERCP) for pancreaticobiliary disease in children: our institutional experience in 231 cases

  • Alana K. Otto
  • Matthew D. Neal
  • Adam N. Slivka
  • Timothy D. Kane



Endoscopic retrograde cholangiopancreatography (ERCP) is an important tool used by clinicians in the diagnosis and management of pancreaticobiliary disease. The safety and utility of ERCP for adults has been well documented. However, experience with ERCP for pediatric patients remains limited. This study aimed to examine the utility and safety of ERCP for diagnosis and therapy in pediatric surgical conditions.


An institutional review board–approved retrospective chart review of all children younger than 21 years who underwent ERCP at a single children’s hospital between 1992 and 2008 was performed. Age, sex, medical history, presenting symptoms, laboratory values, and discharge diagnoses were recorded. The ERCP findings, interventions performed, complications, and associated surgical procedures also were recorded.


A total of 231 ERCPs were performed for 167 children (98 girls and 69 boys) ages 62 days to 21 years. The mean patient age was 11.4 years, with 11% (n = 18) of the ERCPs performed for children younger than 2 years. Common indications for ERCP included chronic or recurrent pancreatitis (n = 106), acute pancreatitis (n = 42), and choledocholithiasis (n = 26). Additional indications included choledochal cyst (n = 2), congenital biliary obstruction (n = 2), and malignant biliary obstruction (n = 1). Therapeutic interventions were performed in 159 cases (69%) including sphincterotomy (n = 96), stone extraction (n = 55), and stent insertion (n = 52). Complications occurred for only 11 patients (4.76%), including 7 cases of post-ERCP pancreatitis. The use of ERCP for imaging resulted in surgical procedures in 58 cases.


Endoscopic retrograde cholangiopancreatography was used most commonly for children with pancreatitis and gallstone disease. It was used frequently for infants with a low complication rate. The majority of patients required therapeutic intervention, suggesting an important role for ERCP in the management of pancreaticobiliary disease in infants and children.


Endoscopic cholangiopancreatography ERCP Pediatrics 


  1. 1.
    Cohen S, Bacon BR, Berlin JA, Fleischer D, Hecht GA, Loehrer PJ Sr, McNair AE Jr, Mulholland M, Norton NJ, Rabeneck L, Ransohoff DF, Sonnenberg A, Vannier MW (2002) National Institutes of Health State-of-the-Science Conference Statement: ERCP for diagnosis and therapy, January 14–16, 2002. Gastrointest Endosc 56:803–809PubMedCrossRefGoogle Scholar
  2. 2.
    Durakbasa CU, Balik E, Yamaner S, Bulut T, Büyükuncu Y, Sökücü N, Akyüz A, Bugra D (2008) Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in children and adolescents: experience in a single institution. Eur J Pediatr Surg 18:241–244PubMedCrossRefGoogle Scholar
  3. 3.
    Paris C, Bejjani J, Beaunoyer M, Ouimet A (2010) Endoscopic retrograde cholangiopancreatography is useful and safe in children. J Pediatr Surg 45:938–942PubMedCrossRefGoogle Scholar
  4. 4.
    Artifon EL, Chu A, Freeman M, Sakai P, Usmani A, Kumar A (2010) A comparison of the consensus and clinical definitions of pancreatitis with a proposal to redefine post-endoscopic retrograde cholangiopancreatography pancreatitis. Pancreas 39:530–535PubMedCrossRefGoogle Scholar
  5. 5.
    Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, Liguory C, Nickl N (1991) Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 37:383–393PubMedCrossRefGoogle Scholar
  6. 6.
    Adler DG, Baron TH, Davila RE, Egan J, Hirota WK, Leighton JA, Qureshi W, Rajan E, Zuckerman MJ, Fanelli R, Wheeler-Harbaugh J, Faigel DO (2005) ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc 62:1–8PubMedCrossRefGoogle Scholar
  7. 7.
    Stringer MD, Taylor DR, Soloway RD (2003) Gallstone composition: are children different? J Pediatr 142:435–440PubMedCrossRefGoogle Scholar
  8. 8.
    Buckley A, Connon JJ (1990) The role of ERCP in children and adolescents. Gastrointest Endosc 36:369–372PubMedCrossRefGoogle Scholar
  9. 9.
    Poddar U, Thapa BR, Bhasin DK, Prasad A, Nagi B, Singh K (2001) Endoscopic retrograde cholangiopancreatography in the management of pancreaticobiliary disorders in children. J Gastroenterol Hepatol 16:927–931PubMedCrossRefGoogle Scholar
  10. 10.
    Petersen BT (2004) An evidence-based review of sphincter of Oddi dysfunction: part I. Presentations with “objective” biliary findings (types I and II). Gastrointest Endosc 59:525–534PubMedCrossRefGoogle Scholar
  11. 11.
    Nair RJ, Lawler L, Miller MR (2007) Chronic pancreatitis. Am Fam Physician 76:1679–1688PubMedGoogle Scholar
  12. 12.
    Kamelmaz I, Elitsur Y (1999) Pancreas divisum: the role of ERCP in children. W V Med J 95:14–16PubMedGoogle Scholar
  13. 13.
    Cotton PB, Laage NJ (1982) Endoscopic retrograde cholangiopancreatography in children. Arch Dis Child 57:131–136PubMedCrossRefGoogle Scholar
  14. 14.
    Dite P, Vacek E, Stefan H, Koudelka J, Pozler O, Králová M (1992) Endoscopic retrograde cholangiopancreatography in childhood. Hepatogastroenterology 39:291–293PubMedGoogle Scholar
  15. 15.
    Sharma SS, Maharshi S (2008) Endoscopic management of pancreatic pseudocyst in children: a long-term follow-up. J Pediatr Surg 43:1636–1639PubMedCrossRefGoogle Scholar
  16. 16.
    Cotton PB (2006) Analysis of 59 ERCP lawsuits, mainly about indications. Gastrointest Endosc 63:378–382 quiz 464PubMedCrossRefGoogle Scholar
  17. 17.
    Cheng CL, Fogel EL, Sherman S, McHenry L, Watkins JL, Croffie JM, Gupta SK, Fitzgerald JF, Lazzell-Pannell L, Schmidt S, Lehman GA (2005) Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography in children: a large series report. J Pediatr Gastroenterol Nutr 41:445–453PubMedCrossRefGoogle Scholar
  18. 18.
    Loperfido S, Angelini G, Benedetti G, Chilovi F, Costan F, De Berardinis F, De Bernardin M, Ederle A, Fina P, Fratton A (1998) Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 48:1–10PubMedCrossRefGoogle Scholar
  19. 19.
    Guibaud L, Bret PM, Reinhold C, Atri M, Barkun AN (1995) Bile duct obstruction and choledocholithiasis: diagnosis with MR cholangiography. Radiology 197:109–115PubMedGoogle Scholar
  20. 20.
    Becker CD, Grossholz M, Becker M, Mentha G, de Peyer R, Terrier F (1997) Choledocholithiasis and bile duct stenosis: diagnostic accuracy of MR cholangiopancreatography. Radiology 205:523–530PubMedGoogle Scholar
  21. 21.
    Varghese JC, Farrell MA, Courtney G, Osborne H, Murray FE, Lee MJ (1999) A prospective comparison of magnetic resonance cholangiopancreatography with endoscopic retrograde cholangiopancreatography in the evaluation of patients with suspected biliary tract disease. Clin Radiol 54:513–520PubMedCrossRefGoogle Scholar
  22. 22.
    Chan YL, Chan AC, Lam WW, Lee DW, Chung SS, Sung JJ, Cheung HS, Li AK, Metreweli C (1996) Choledocholithiasis: comparison of MR cholangiography and endoscopic retrograde cholangiography. Radiology 200:85–89PubMedGoogle Scholar
  23. 23.
    Soto JA, Barish MA, Yucel EK, Clarke P, Siegenberg D, Chuttani R, Ferrucci JT (1995) Pancreatic duct: MR cholangiopancreatography with a three-dimensional fast spin-echo technique. Radiology 196:459–464PubMedGoogle Scholar
  24. 24.
    Vegting IL, Tabbers MM, Taminiau JA, Aronson DC, Benninga MA, Rauws EA (2009) Is endoscopic retrograde cholangiopancreatography valuable and safe in children of all ages? J Pediatr Gastroenterol Nutr 48:66–71PubMedCrossRefGoogle Scholar
  25. 25.
    Iqbal CW, Baron TH, Moir CR, Ishitani MB (2009) Post-ERCP pancreatitis in pediatric patients. J Pediatr Gastroenterol Nutr 49:430–434PubMedCrossRefGoogle Scholar
  26. 26.
    Prasil P, Laberge JM, Barkun A, Flageole H (2001) Endoscopic retrograde cholangiopancreatography in children: a surgeon’s perspective. J Pediatr Surg 36:733–735PubMedCrossRefGoogle Scholar
  27. 27.
    Varadarajulu S, Wilcox CM, Hawes RH, Cotton PB (2004) Technical outcomes and complications of ERCP in children. Gastrointest Endosc 60:367–371PubMedCrossRefGoogle Scholar
  28. 28.
    Andriulli A, Loperfido S, Napolitano G, Niro G, Valvano MR, Spirito F, Pilotto A, Forlano R (2007) Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 102:1781–1788PubMedCrossRefGoogle Scholar
  29. 29.
    Wang P, Li ZS, Liu F, Ren X, Lu NH, Fan ZN, Huang Q, Zhang X, He LP, Sun WS, Zhao Q, Shi RH, Tian ZB, Li YQ, Li W, Zhi FC (2009) Risk factors for ERCP-related complications: a prospective multicenter study. Am J Gastroenterol 104:31–40PubMedCrossRefGoogle Scholar
  30. 30.
    Rabenstein T, Schneider HT, Nicklas M, Ruppert T, Katalinic A, Hahn EG, Ell C (1999) Impact of skill and experience of the endoscopist on the outcome of endoscopic sphincterotomy techniques. Gastrointest Endosc 50:628–636PubMedCrossRefGoogle Scholar
  31. 31.
    Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fennerty MB, Ryan ME, Shaw MJ, Lande JD, Pheley AM (1996) Complications of endoscopic biliary sphincterotomy. N Engl J Med 335:909–918PubMedCrossRefGoogle Scholar
  32. 32.
    Putnam PE, Kocoshis SA, Orenstein SR, Schade RR (1991) Pediatric endoscopic retrograde cholangiopancreatography. Am J Gastroenterol 86:824–830PubMedGoogle Scholar
  33. 33.
    Cotton PB, Garrow DA, Gallagher J, Romagnuolo J (2009) Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc 70:80–88PubMedCrossRefGoogle Scholar
  34. 34.
    Tanner AR (1996) ERCP: present practice in a single region: suggested standards for monitoring performance. Eur J Gastroenterol Hepatol 8:145–148PubMedCrossRefGoogle Scholar
  35. 35.
    Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, Dinelli M, Minoli G, Crosta C, Comin U, Fertitta A, Prada A, Passoni GR, Testoni PA (2001) Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol 96:417–423PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Alana K. Otto
    • 1
  • Matthew D. Neal
    • 1
  • Adam N. Slivka
    • 2
  • Timothy D. Kane
    • 3
  1. 1.Division of Pediatric General and Thoracic SurgeryUniversity of Pittsburgh Medical Center, Children’s Hospital of Pittsburgh of UPMCPittsburghUSA
  2. 2.Division of Gastroenterology, Hepatology & Nutrition, Department of MedicineUniversity of Pittsburgh Medical CenterPittsburghUSA
  3. 3.Division of Pediatric General and Thoracic SurgeryChildren’s National Medical CenterWashingtonUSA

Personalised recommendations