Pediatric Endoscopic Retrograde Cholangiopancreatography (ERCP)

What is pediatric ERCP?

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that helps diagnose and treat conditions in the liver, gallbladder and pancreas. ERCP uses a long, thin, flexible tube with a tiny light and camera at the tip (endoscope). During the procedure, we give your child medicine that puts them in a sleep-like state and blocks pain (general anesthesia).

We guide the scope through your child’s mouth, down their esophagus (food pipe), through their stomach and into the first part of the small intestine. An ERCP can show problems such as blockages, narrowing or stones in the liver, gallbladder, pancreas and the ducts (tubes) that drain these organs.

What are the benefits of pediatric ERCP?

The key benefit of pediatric ERCP is that it allows doctors to evaluate, diagnose and treat problems during one procedure. Other imaging tests provide pictures of the organs and their ducts, but they don’t allow for internal tests or treatment.

During ERCP, doctors can:

• View the bile and pancreatic ducts, which connect the liver, gallbladder and pancreas

• Take a tissue sample to examine in the lab for signs of disease (biopsy)

• Perform certain treatments, when possible

Your child may need an ERCP if they have signs and symptoms of gallbladder, liver or pancreatic disease. Our pediatric gastroenterologists (specialists in digestive disorders) use ERCP to diagnose conditions and symptoms including:

• Abdominal (belly) pain

• Autoimmune hepatitis

• Bile duct and pancreas disease

• Enlarged liver or spleen

• Gallbladder disease such as gallstones

• Jaundice

• Narrowing (strictures) inside a duct

• Pancreatitis

• Tumors

What are the side effects of pediatric ERCP?

After pediatric ERCP, some children might experience side effects, which may include:

• Bloating and discomfort due to gas

• Fatigue (tiredness)

• Nausea and vomiting

• Sore throat for a day or two

• Temporary inflammation (swelling) in the pancreas or liver

The expert care team at Children's Health℠ knows what to look for after ERCP and can help your child feel better quickly if they have any side effects.

What are the risks of pediatric ERCP?

Pediatric ERCP is a safe and effective procedure. As with any procedure, it has some risks. We work hard to minimize your child’s risks – your child’s health and safety are our highest priorities.

Our doctor will discuss with you the possible risks for your child, which may include:

• Bleeding, especially if a biopsy was done

• ERCP-related pancreatitis (temporary)

• Infection

• Reaction to anesthesia medication

• Tear (perforation) in the small intestine, bile duct or pancreatic duct (very rare)

• Shifting of stents (small tubes that help with drainage), if used

What to expect with pediatric ERCP

Our pediatric endoscopists are gastroenterologists who have specialized training in all the latest minimally invasive endoscopic procedures for children. Our GI endoscopy teams have extensive experience and training in pediatric health care, and we focus exclusively on GI care for children. Your child’s care is in expert hands with our team.

What to expect before pediatric ERCP

Your child’s gastroenterologist will explain the procedure to you and answer your questions. Once we schedule the procedure, our scheduler will call you and send you a letter with the date of the ERCP.

Child Life specialists can meet with your child before the procedure to help them understand what will happen and put them at ease. If you’d like a specialist for your child, ask your child’s care team.

We provide detailed instructions for preparing your child before the ERCP and how to take care of them after. We will tell you what time your child should stop drinking and eating before the procedure, and what time you should check in.

What to expect during pediatric ERCP

As we prepare your child, we will spray a numbing medicine in their mouth and throat for their comfort. You can be with them until our pediatric anesthesiologist gives them general anesthesia, and then you can go to the waiting room during the procedure.

To begin, the gastroenterologist will guide the endoscope through your child’s mouth to the area of the small intestine where the bile duct begins. Through the scope, the doctor injects a special dye (called contrast medium) that shows up on X-rays. We then take X-rays to see the locations of blockages, narrowing, gallstones or other problems.

The doctor may also pass tiny instruments through the scope to:

• Take tiny samples of tissue that will be examined in the lab to diagnose diseases

• Break up and remove stones from inside ducts

• Widen narrowed or blocked ducts

• Place stents (tiny plastic or metal tubes) to hold ducts open

What to expect after pediatric ERCP

A nurse will take your child to the post-anesthesia care unit (PACU, also called the wake-up room). After the anesthesia wears off, the nurse may give your child clear liquids.

Your child's doctor will speak with you about how the procedure went, then you can join your child in the wake-up room. Our care team will provide complete instructions on how to care for your child at home. You can take them home after about one hour in the wake-up room.

If we did another test or treatment during the ERCP, we usually have the results in about 7 days. Your child’s care team will call you with the results.

What questions should I ask my provider about pediatric ERCP?

As you work with your child’s care team to plan their treatment, questions that can help you understand ERCP include:

• Are there other test or treatment options for my child?

• What medications should my child stop taking before pediatric ERCP?

• How soon will I be able to see my child after pediatric ERCP?

• Will my child need to spend the night at the hospital after pediatric ERCP?

• Will my child go home with any special equipment after pediatric ERCP?