Endoscopic Retrograde Cholangiopancreatography in Pediatric Populations

  • Mayssan Muftah
  • Rushikesh Shah
  • Chris Fritzen
  • Cary G. Sauer
  • Alvin J. Freeman
  • Field F. WillinghamEmail author
Invited Commentary


Endoscopic retrograde cholangiopancreatography (ERCP) has grown in its utility in the pediatric population since it was first described. The overall number of pediatric ERCPs performed has increased due to an increased incidence of pancreatobiliary disease in the pediatric population. Despite increased use, there is limited data regarding the efficacy and safety in pediatric cohorts, and minimal data on measures to minimize post-ERCP complications in children. We aim to discuss the role and safety of ERCP in children, the use of rectal indomethacin for post-ERCP pancreatitis (PEP), and the evolving role of ERCP in managing pancreatobiliary injuries secondary to blunt abdominal trauma.

ERCP in pediatric patients

During the period between 2000 and 2009, a total of 22,153 pediatric ERCPs were performed in the USA, with an overall increase of ERCPs from 5337 to 6733 performed per year. Therapeutic procedures made up 78% of the procedures, largely due to the decline in...


Pediatric endoscopic retrograde cholangiopancreatography Pancreatic duct injury Blunt abdominal trauma Post-ERCP pancreatitis Rectal indomethacin 


References and Recommended Reading

  1. 1.
    Pant C, Sferra TJ, Barth BA, Deshpande A, Minocha A, Qureshi WA, et al. Trends in endoscopic retrograde cholangiopancreatography in children within the United States, 2000-2009. J Pediatr Gastroenterol Nutr. 2014;59(1):57–60.CrossRefGoogle Scholar
  2. 2.
    Limketkai BN, Chandrasekhara V, Kalloo AN, Okolo PI. Comparison of performance and safety of endoscopic retrograde cholangiopancreatography across pediatric age groups. Dig Dis Sci. 2013;58(9):2653–60.CrossRefGoogle Scholar
  3. 3.
    Mekaroonkamol P, Shah R, Nieto J, Chawla S, Freeman AJ, Sauer CG, et al. Sa2079 efficacy and safety of rectal indomethacin for prevention of post endoscopic retrograde cholangiopancreatography pancreatitis in a pediatric population. Gastrointest Endosc85(5):AB287-AB8.Google Scholar
  4. 4.
    Rosen JD, Lane RS, Martinez JM, Perez EA, Tashiro J, Wagenaar AE, et al. Success and safety of endoscopic retrograde cholangiopancreatography in children. J Pediatr Surg. 2017;52(7):1148–51.CrossRefGoogle Scholar
  5. 5.
    Shah R, Mekaroonkamol P, Taylor A, Freeman AJ, Fritzen C, Chawla S, et al. Tu1988 safety and efficacy of endoscopic retrograde cholangiopancreatography in pediatric patients: an 8 year experience from a multi-center study. Gastrointest Endosc 2018;87(6):AB610-AB1.Google Scholar
  6. 6.
    Usatin D, Fernandes M, Allen IE, Perito ER, Ostroff J, Heyman MB. Complications of endoscopic retrograde cholangiopancreatography in pediatric patients; a systematic literature review and meta-analysis. J Pediatr. 2016;179:160–5 e3.Google Scholar
  7. 7.
    Committee ASoP, Chandrasekhara V, Khashab MA, Muthusamy VR, Acosta RD, Agrawal D, et al. Adverse events associated with ERCP. Gastrointest Endosc. 2017;85(1):32–47.CrossRefGoogle Scholar
  8. 8.
    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(6):1408–16.CrossRefGoogle Scholar
  9. 9.
    Iqbal CW, Baron TH, Moir CR, Ishitani MB. Post-ERCP pancreatitis in pediatric patients. J Pediatr Gastroenterol Nutr. 2009;49(4):430–4.CrossRefGoogle Scholar
  10. 10.
    Mekaroonkamol P, Nieto J, Chawla S, Freeman AJ, Alnoah Z, Keilin S, et al. Sa2065 a multicenter evaluation of therapeutic endoscopic retrograde cholangiopancreatography in pediatric populations. Gastrointest Endosc83(5):AB303-AB4.Google Scholar
  11. 11.
    Englum BR, Gulack BC, Rice HE, Scarborough JE, Adibe OO. Management of blunt pancreatic trauma in children: review of the National Trauma Data Bank. J Pediatr Surg. 2016;51(9):1526–31.CrossRefGoogle Scholar
  12. 12.
    Garvey EM, Haakinson DJ, McOmber M, Notrica DM. Role of ERCP in pediatric blunt abdominal trauma: a case series at a level one pediatric trauma center. J Pediatr Surg. 2015;50(2):335–8.CrossRefGoogle Scholar
  13. 13.
    Rosenfeld EH, Vogel AM, Klinkner DB, Escobar M, Gaines B, Russell R, et al. The utility of ERCP in pediatric pancreatic trauma. J Pediatr Surg. 2017.Google Scholar
  14. 14.
    Naseemuddin R, Fritzen CS, Freeman AJ, Keilin S, Cai Q, Willingham F. Tu1989 endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic duct (PD) stent placement for the management of grade 3 or higher pancreatic injuries in children with blunt abdominal trauma. Gastrointest Endosc. 2018;87(6):AB611.CrossRefGoogle Scholar
  15. 15.
    Soukup ES, Russell KW, Metzger R, Scaife ER, Barnhart DC, Rollins MD. Treatment and outcome of traumatic biliary injuries in children. J Pediatr Surg. 2014;49(2):345–8.CrossRefGoogle Scholar
  16. 16.
    Kulaylat AN, Stokes AL, Engbrecht BW, McIntyre JS, Rzucidlo SE, Cilley RE. Traumatic bile leaks from blunt liver injury in children: a multidisciplinary and minimally invasive approach to management. J Pediatr Surg. 2014;49(3):424–7.CrossRefGoogle Scholar
  17. 17.
    Keil R, Drabek J, Lochmannova J, Stovicek J, Rygl M, Snajdauf J, et al. Endoscopic treatment of bile duct post-traumatic and post-operative lesions in children. Scand J Gastroenterol. 2017;52(8):870–5.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Mayssan Muftah
    • 1
  • Rushikesh Shah
    • 2
  • Chris Fritzen
    • 3
  • Cary G. Sauer
    • 3
  • Alvin J. Freeman
    • 3
  • Field F. Willingham
    • 2
    • 3
    Email author
  1. 1.Department of MedicineEmory University School of MedicineAtlantaUSA
  2. 2.Department of Medicine, Division of Digestive DiseasesEmory University School of MedicineAtlantaUSA
  3. 3.Gastroenterology, Hepatology and Nutrition, Children’s Healthcare of AtlantaEmory University School of MedicineAtlantaUSA

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