For a study, researchers sought to conduct a retrospective analysis of all Endoscopic retrograde cholangiopancreatography (ERCPs) that involved cholangioscopy at a tertiary care children’s hospital from 2015 to 2020 to understand better how this procedure is used in young patients. The patient characteristics, procedure indications, interventions, and adverse events related to these procedures were all investigated. At the children’s hospital during the study period, 282 kids underwent 307 ERCPs. In 36 surgeries, cholangioscopy was used (11.7%). Before cholangioscopy, all patients received antibiotics to cover biliary organisms. Patient age, on average, was 13.6 years (range 7–18 years). The two most frequent reasons for cholangioscopy were to evaluate a biliary stricture and perform electrohydraulic lithotripsy for biliary stone disease (with incidental finding of biliary web in 2 patients and retained suture material in 2 patients). Compared to patients who underwent ERCP, patients with cholangioscopy experienced fewer adverse effects. About 1 patient experienced self-limited melena, while 0/36 (or 0%) of patients suffered post-ERCP pancreatitis (possible self-limited post sphincterotomy bleeding). Cholangioscopy helped 30 out of 36 pediatric patients (83.3%). These data show that cholangioscopy is safe and helpful for children and adolescents. Cholangioscopy was used in just over 11% of pediatric patients with an ERCP at the academic medical center. This rate is similar to the rate reported in adult patients. The radiation-saving nature of cholangioscopy, with data supporting its safety, makes it particularly appealing for use in children. It would be helpful to continue to evaluate the utility, safety, and range of indications for cholangioscopy in other practice settings.