success and adverse effect rates of endoscopic retrograde cholangiopancreatography as a therapeutic method among children: a systematic review and meta-analysis

Background: although the invention of more specialized duodenoscopes helped to develop endoscopic retrograde cholangiopancreatography (ercp) as a therapeutic method in children, there is a general perception that ercp is practically challenging and dangerous in children. this has limited its widespread use in children. the aim of this meta-analysis is to update the previous reviews and evaluate more recent outcomes and complications of therapeutic ercp among children with hpb disease.methods: a systematic literature search based on the preferred reporting items for systematic reviews and meta-analyses (prisma) was performed in web of science, embase, pubmed, and cochrane library databases to find and evaluate all articles regarding therapeutic ercp in children with hpb diseases published from january 2017 to july 2022. the analysis included studies that evaluated patients less than 18 years old undergoing ercp with the objective of hpb diseases, and had reported the success rate and side effects. the main outcome measures were the success and complication rate of therapeutic ercp. this meta-analysis was performed using stata version 16 (statacorp lp, college station, texas).results: a total of 10 articles consisting of 1924 ercp, performed on 958 children, were included. out of all ercps, 96% (95%ci: 96-97, i2:95.8%) were conducted with therapeutic goals. the overall success rate among therapeutic ercps was 91% (95ci:90-92%, i2:97.1%) ranging from 65% to 95% among different studies. an overall of 9% (95%ci: 8-10, i2:97.8%) of all therapeutic ercps were associated with different adverse effects such as postoperative pancreatitis (6%) and hemorrhage (1%).conclusion: our analysis suggested ercp as a safe therapeutic method for pediatric patients suffering hpb patients, having a success rate of 91% and a complication rate of 9%, none of which led to in-hospital mortality.