Pediatric endoscopic retrograde cholangiopancreatography: A systematic review of indications, technical success, adverse events, and complication prevention

doi:10.4253/wjge.125072

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World Journal of Gastrointestinal Endoscopy

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1948-5190

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Systematic Reviews

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Endosc. Sep 16, 2026; 18(9): 125072
Published online Sep 16, 2026. doi: 10.4253/wjge.125072

Pediatric endoscopic retrograde cholangiopancreatography: A systematic review of indications, technical success, adverse events, and complication prevention

Jun Shu, Jun Yang

Jun Shu, Jun Yang, Department of Gastrointestinal Surgery, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430016, Hubei Province, China

Co-corresponding authors: Jun Shu and Jun Yang.

Author contributions: Shu J conceived the review topic, designed the study framework, coordinated the project, developed the literature search strategy, screened and interpreted the relevant literature, and drafted the manuscript; Yang J supervised the project, provided overall academic and clinical guidance, reviewed the manuscript critically for important intellectual content, and approved the final version for submission; Shu J and Yang J contributed to the development of the review, revised the manuscript, and approved the final version for publication as co-corresponding authors.

AI contribution statement: The authors take full responsibility and accountability for all content of this manuscript, including any portions for which AI tools were used as assistive technologies. All AI-assisted outputs were carefully reviewed, validated, and approved by the authors. AI tools were not used to generate original scientific data, perform independent scientific analyses, or draw scientific conclusions.

Conflict-of-interest statement: Both authors declare no conflict of interest in publishing the manuscript.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Jun Yang, Associate Professor, Department of Gastrointestinal Surgery, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No. 100 Hongkong Road, Jiang’an District, Wuhan 430016, Hubei Province, China. yangjun@zgwhfe.com

Received: July 1, 2026
Revised: July 8, 2026
Accepted: August 5, 2026
Published online: September 16, 2026
Processing time: 73 Days and 18.5 Hours

Abstract

BACKGROUND

Pediatric endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a mainly diagnostic test into a predominantly therapeutic intervention for pancreatobiliary disease. Yet children differ from adults in body size, anesthetic requirements, radiation sensitivity, pancreaticobiliary anatomy, and access to appropriately sized equipment. Current evidence remains fragmented across indications, techniques, adverse-event definitions, and prevention strategies, and reporting of post-ERCP pancreatitis (PEP) is inconsistent. We reasoned that a descriptive, endpoint-specific synthesis of recent studies would characterize practice, outcomes, and safety more faithfully than pooled estimates derived from incompatible denominators.

AIM

To synthesize recent evidence on pediatric ERCP indications, technical success, adverse events, PEP, and its prevention.

METHODS

PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane Library were searched. After deduplication and two-stage screening, 356 full-text reports were assessed, 144 underwent data extraction, and 128 studies were retained following post-extraction quality verification. Given the clinical and methodological heterogeneity, no meta-analysis was performed; instead, study-level outcomes were summarized descriptively with endpoint-specific denominators, reporting medians, interquartile range (IQR), and counts.

RESULTS

The 128 studies were published from 2017 to 2026, with 101 (78.9%) appearing since 2020; single-center retrospective series predominated (70 studies, 54.7%). The United States and China were the leading data sources (32 studies each, 25.0%). Pancreatitis or pancreatic-duct disease (82 studies, 64.1%) and choledocholithiasis (81 studies, 63.3%) were the dominant indications, and ERCP was primarily therapeutic (88 studies, 68.8%). Median study-level technical success was 94.7% (IQR: 89.8%-97.2%; 49 studies), median PEP rate was 5.2% (IQR: 3.0%-9.5%; 39 studies), and median overall adverse-event rate was 8.9% (IQR: 3.2%-14.2%; 89 studies).

CONCLUSION

Pediatric ERCP is generally technically successful, and PEP remains the principal procedure-related adverse event. Standardized definitions, prospective registries, and pediatric-specific PEP prevention trials are needed.

Keywords: Children; Endoscopic retrograde cholangiopancreatography; Post-endoscopic retrograde cholangiopancreatography pancreatitis; Adverse events; Biliary tract diseases; Pancreatic diseases; Choledocholithiasis; Systematic review

Core Tip: This systematic review synthesizes recent evidence on pediatric endoscopic retrograde cholangiopancreatography from a finalized 128-study dataset. Rather than pooling event rates across incompatible definitions, it emphasizes endpoint-specific denominators. Contemporary studies show high study-level technical success (median 94.7%), whereas post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP; median 5.2%) remains the principal procedure-related adverse event. The review highlights persistent reporting gaps and the need for standardized pediatric definitions, prospective multicenter registries, and pediatric-specific PEP prevention trials, including those of rectal nonsteroidal anti-inflammatory drugs and pancreatic-duct stents.