S2251 Safety and Efficacy of Endoscopic Retrograde Cholangiopancreatography for Pancreatic Divisum in the Pediatric Population: Systematic Review and Meta-Analysis

Introduction: Pancreas divisum (PD) is the most common congenital anomaly of the pancreas. Although many PD patients are asymptomatic, some may experience recurrent acute pancreatitis (RAP), chronic pancreatitis (CP). Current evidence related to the utility of endoscopic retrograde cholangiopancreatography (ERCP) in PD has been mostly limited to adults. We conducted a systematic review and meta-analysis of the safety and efficacy of ERCP for PD in the pediatric population. Methods: A systematic review of the literature from PubMed, Web of Science, Cochrane, EMBASE and Scopus was conducted from inception to February 2025, for studies assessing the safety and efficacy of ERCP in pediatric PD. The primary outcomes of interest was clinical success. Secondary outcomes included clinical remission, technical success, and post-ERCP pancreatitis. Pooled effect estimates were calculated using a random-effects model and expressed as proportions with 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic. Results: A total of 8 retrospective studies were included that reported on 252 patients. Males comprised 39.7% of participants, and the median age ranged from 9 to 14 years. Median follow-up post-ERCP ranged from 12 to 41 months. The pooled rate of clinical success was 83.7% (95% CI: 76.6%-90.8%; I2 = 42.53%). The pooled rate of clinical remission was 41.5% (95% CI: 18.6-64; I2 = 87.65%), while the pooled rate of technical success was 96.9% (95% CI: 94.3-99.6; I2 = 38.76%). The pooled rate of post-ERCP pancreatitis was 13.9% (95% CI: 7.9-20; I2 = 56.15%). In patients with PD presenting as recurrent acute pancreatitis (RAP), the pooled rate of clinical success was 81.6% (95% CI: 60.4-100; I2 = 91.3%), while in PD patients with chronic pancreatitis, the pooled rate of clinical success was 70.8% (95% CI: 58.3-83.3; I2 = 0%). Conclusion: Our meta-analysis demonstrates that ERCP is an effective and safe procedure in pediatric patients with PD, particularly when presenting with RAP. It also has a high rate of technical success, but further large-scale prospective studies are needed to better understand its role and safety in this population.