Cincinnati Children’s is one of only a few pediatric medical centers in the country that offers a special procedure performed by a pediatric endoscopist called an endoscopic retrograde cholangiopancreatography (ERCP).

This procedure is used to diagnose and treat problems in the pancreas. These problems may be in the duct or in the pancreas itself.

Who Is a Candidate for ERCP?

ERCP can be done on children of any age, including newborns and infants, and is typically offered for patients with:

• Acute recurrent pancreatitis
• Chronic pancreatitis
• Injuries to the duct
• Gallstone disease causing pancreatitis
• Inflammatory disorders affecting the pancreas
• Stones blocking the pancreatic duct
• Narrowing (strictures) within the duct
• Abnormal anatomy of the pancreas or duct

What Is Involved in ERCP?

During an ERCP, the doctor uses a special narrow, flexible tube (endoscope) that has a video camera. While the child is asleep, the tube is placed through the child’s mouth into the upper digestive system. Contrast dye with X-rays allow the doctor to see stones, abnormal narrowing or blockages in the ducts. To treat these problems, the doctor slides tiny surgical tools through the endoscope to treat the problems they find.

Sometimes the procedure is used only to diagnosis a problem. Most ERCP procedures involve treatment. Treatment can include:

• Sphincterotomy − an incision to increase the size of the opening of the pancreatic duct
• Stent placement − inserting a temporary, small, plastic tube within the duct to make sure that drainage can happen
• Stone extraction − used to clear the ducts of stones
• Stricture dilation − used to stretch or expand an area where the duct is abnormally narrow or small

ERCP can take anywhere from 20 minutes to two hours, depending on the type of treatment needed.

After the procedure the doctor will talk with families. They will discuss what was found, the treatment that was done, and answer any questions. The doctor will talk about anticipated recovery time and future plan of care, which may include the need for a repeat ERCP.

What Is the Recovery Period Like?

After an ERCP, most children are able to eat and drink normally soon after recovering from the sedation (anesthesia). Most children will stay in the hospital overnight for observation and are allowed to go home the next day.

Some children may develop temporary complications. The most common is ERCP-related pancreatitis, a temporary inflammation of the pancreas. This can require a longer hospital stay of between two and five days to recover.

After the child is sent home, they will return for a follow-up appointment. In some cases, another ERCP procedure is needed to achieve the desired outcome.