An ERCP is a non-invasive procedure that allows doctors to treat problems in the liver, gallbladder, bile ducts, pancreas and pancreatic duct. In children, they’re most commonly performed to remove a gallstone.

The procedure combines two components: an endoscopy and fluoroscopic x-rays:

An endoscopy is a procedure that lets the doctor look at the upper parts of your child’s digestive system, including the esophagus, stomach, liver, bile ducts, pancreas, pancreatic duct and gall bladder.

During an endoscopy, while your child is under general anesthesia, the doctor guides an endoscope—a long, thin, flexible tube equipped with LED lights and a tiny video camera that transmits to several monitors in the room—into your child’s mouth and down into his upper digestive system.

Even though the endoscope is extremely narrow,  it is divided into two “channels.” The doctor can use the channels to:

  • transfer air into the GI tract, to make sure there’s enough room for what he or she needs to do
  • deliver medicine such as steroids straight into your child’s GI tract
  • slide tools through that will allow him or her to remove an obstruction or work within these tiny areas

Some areas of the body (such as the bile ducts) are so small that in order to see into them, the doctor needs to use the endoscope to inject them with a special contrast dye. This dye is visible in fluoroscopic x-rays, which show any abnormal narrowing or blockages in the duct. 

ERCP stands for endoscopic retrograde cholangiopancreatography:

  • endoscopicrefers to the user of the endoscope
  • retrograderefers to going against the direction of the flow of bile
  • cholangiopancreatographyrefers to making images of the bile ducts and pancreatic duct

ERCP at Children’s Hospital Boston

Here at Children’s, ERCPs are performed by the experienced clinicians of our Gastroenterology Procedure Unit (GPU)—a full-service unit providing an array of diagnostic and therapeutic endoscopy procedures in a safe, comfortable environment.

Offering more than the typical gastroenterology (GI) endoscopy center, our specialists provide world-renowned care to children with gastrointestinal, pancreatic and hepatobiliary disorders. Our team includes 19 attending physicians, 12 nurses and 6 endoscopy technicians who support the day-to-day practice of the unit. We also assist in the care of children with life-threatening cases in other areas of the hospital, such as the intensive care and surgical units, using our portable equipment. All nurses and physicians are certified in pediatric advanced life support (PALS).


Elliott Cleckler was born with long-gap esophageal atresia—a serious condition that is notoriously difficult to treat. In this short video series, his parents, Jay and Heather, share their story.

ERCP: Reviewed by Michael Manfredi, MD

© Children’s Hospital Boston, 2011

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