Gholam Reza Sivandzadeh - Associated Professor of Gastroenterology and Hepatology, Department of Internal Medicine, Gastroenterohepatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Ali Reza Taghavi - Professor of gastroenterology and hepatology, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Mahmoud Haghighat - Gastroenterohepatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Seyed Mohsen Dehghani - Gastroenterohepatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Maryam Ataollahi - Gastroenterohepatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Morteza Salarzaei - Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran
Fateme Parooie - Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran
Masoud Tahani - Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran .
Iraj Shahramian - Professor of Pediatric Gastroenterology and Hepatology, Pediatric gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran

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 ۲۰۱۷ to July ۲۰۲۲. The analysis included studies that evaluated patients less than ۱۸ 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 ۱۶ (StataCorp LP, College Station, Texas). Results: A total of ۱۰ articles consisting of ۱۹۲۴ ERCP, performed on ۹۵۸ children, were included. Out of all ERCPs, ۹۶% (۹۵%CI: ۹۶-۹۷, I۲:۹۵.۸%) were conducted with therapeutic goals. The overall success rate among therapeutic ERCPs was ۹۱% (۹۵CI:۹۰-۹۲%, I۲:۹۷.۱%) ranging from ۶۵% to ۹۵% among different studies. An overall of ۹% (۹۵%CI: ۸-۱۰, I۲:۹۷.۸%) of all therapeutic ERCPs were associated with different adverse effects such as postoperative pancreatitis (۶%) and Hemorrhage (۱%). Conclusion: Our analysis suggested ERCP as a safe therapeutic method for pediatric patients suffering HPB patients, having a success rate of ۹۱% and a complication rate of ۹%, none of which led to in-hospital mortality.

Endoscopic Retrograde Cholangiopancreatography (ERCP), Success rate, Adverse Effect Rate, Pediatric