Abstract / Summary
Background: Pancreas divisum (PD) may be associated with recurrent acute pancreatitis (RAP) or chronic pancreatitis (CP), but data on ERCP outcomes in children with PD are limited. We conducted a systematic review of the clinical, technical, and safety outcomes of ERCP for PD in children. Methods: Multiple databases were searched through May 2025. The primary outcome was clinical response, as defined by each individual study; secondary outcomes were symptom resolution, technical success, and post-ERCP pancreatitis (PEP). Because outcome definitions and interventions varied and no study included a control group, outcomes were summarized narratively and were not pooled. Results: Eight retrospective studies including 247 patients were included. Clinical response ranged from 65.0% to 93.3% across six studies, symptom resolution from 19.1% to 54.1%, and technical success from 77.8% to 100%. Reported PEP ranged from 7.9% to 20.7%, with mixed patient and procedure denominators. Response ranged from 80.0% to 100% in RAP and 60.0% to 87.9% in CP, and was higher in RAP in three of four studies reporting both. Outcome definitions differed for every outcome examined. Conclusions: The available pediatric literature cannot establish whether ERCP is effective in children with PD. Every study was uncontrolled and retrospective, and outcome definitions were not comparable. Reported clinical response was frequent, particularly in RAP, but may in part reflect regression to the mean, and the PEP risk warrants caution. Given the low certainty of evidence and risk of adverse events, in particular PEP, further prospective studies are needed to define the role of ERCP in this population. A core set of outcome definitions and prospective controlled studies are required to determine efficacy.