Technical Outcomes in Pediatric Endoscopic Retrograde Cholangiopancreatography: Data from an International Collaborative

David M. Troendle, Wenly Ruan, Douglas S. Fishman, Bradley A. Barth, Quin Y. Liu, Matthew Giefer, Kyung Mo Kim, Mercedes Martinez, Luigi Dall'Oglio, Filippo Torroni, Paola De Angelis, Simona Faraci, Sam Bitton, Michael Wilsey, Racha Khalaf, Steven Werlin, Kulwinder Dua, Roberto Gugig, Clifton Huang, Petar MamulaJ. Antonio Quiros, Yuhua Zheng, Amit Grover, Victor L. Fox

Research output: Contribution to journalArticlepeer-review


Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) in adults has been extensively studied through multicenter prospective studies. Similar pediatric studies are lacking. The Pediatric ERCP Database Initiative (PEDI) is a multicenter collaborative aiming to evaluate the indications and technical outcomes in pediatric ERCPs. Methods: In this prospective cohort study, data were recorded for pediatric ERCPs performed across 15 centers. A pre-procedure, procedure, 2-week post-procedure follow-up, and adverse event form were completed for each ERCP performed. Univariate and stepwise linear regression was performed to identify factors associated with technically successful procedures and adverse events. Results: A total of 1124 ERCPs were performed on 857 patients from May 1, 2014 to May 1, 2018. The median age was 13.5 years [interquartile range (IQR) 9.0-15.7]. Procedures were technically successful in the majority of cases (90.5%) with success more commonly encountered for procedures with biliary indications [odds ratio (OR) 4.2] and less commonly encountered for native papilla anatomy (OR 0.4) and in children <3 years (OR 0.3). Cannulation was more often successful with biliary cannulation (95.9%) compared to pancreatic cannulation via the major papilla (89.6%, P < 0.0001) or minor papilla (71.2%, P < 0.0005). The most commonly identified adverse events included post-ERCP pancreatitis (5%), pain not related to post-ERCP pancreatitis (1.8%), and bleeding (1.2%). Risk factors for the development of each were identified. Conclusions: This large prospective study demonstrates that ERCP is reliable and safe in the pediatric population. It highlights the utility of PEDI in evaluating the technical outcomes of pediatric ERCPs and demonstrates the potential of PEDI for future studies in pediatric ERCPs.

Original languageEnglish (US)
Pages (from-to)755-760
Number of pages6
JournalJournal of pediatric gastroenterology and nutrition
Issue number6
StatePublished - Dec 1 2022
Externally publishedYes


  • endoscopic retrograde cholangiopancreatography
  • pediatric
  • post-ERCP pancreatitis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology


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