S2181 Dominated by Disparities: Sex and Geographic Inequities in ERCP Research and the Need for Equitable Advancement

Introduction: Endoscopic Retrograde Cholangiopancreatography (ERCP) has been pivotal in diagnosing and managing biliary and pancreatic disorders. While ERCP-related research has grown over the past 2 decades, marked disparities persist in both geographic representation and gender equity. For example, in the 2023 Advanced Endoscopy Fellowship (AEF) match in the United States, only 16% of fellows were women, underscoring a persistent gender gap in interventional endoscopy—a field long dominated by men. Methods: We conducted a bibliometric analysis using the Web of Science Core Collection, including ERCP-related articles published between January 2000 and March 2025. Bibliometric indicators and collaboration metrics were computed using the Bibliometrix R package. Results: A total of 5,162 ERCP-related articles were published across 622 journals. The annual growth rate remained stable until 2019, when a noticeable increase in publication output emerged. Leading journals included Gastrointestinal Endoscopy (667 articles) and Endoscopy (448). The United States led in publication volume (1,348 corresponding-author articles) and total citations (33,291), followed by China, Japan, Italy, and Korea. Italy had the highest average citations per article (29.0). Gender analysis revealed that woman first authors remain severely underrepresented in high-impact ERCP literature. Among the top 50 most-cited articles, only 3 (6%) were led by women. In the top 100, just 9 (9%) of first authors were woman, compared to 91 man first authors (91%). Geographic disparity was equally pronounced. In the top 100 most-cited studies, 60% of first authors were based in the United States, compared to 40% from other countries Among the top 50, 66% were U.S.-based. This imbalance reflects both academic centralization and limited high-impact output from low- and middle-income countries, despite growing global ERCP demand. Conclusion: ERCP research remains heavily concentrated in high-income regions and dominated by man authorship, reflecting structural inequities in opportunity and recognition. Our analysis underscores the urgent need for targeted strategies to promote gender equity and amplify contributions from underrepresented regions. In a field where diversity is essential for innovation, equitable access to academic authorship and mentorship must be prioritized to shape the future of interventional endoscopy.