Endoscopic retrograde cholangiopancreatography in pediatric and adult populations: 17-year experience from Pakistan with trends, complications, and global comparison.

BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) is an essential diagnostic and therapeutic procedure for pancreatobiliary disorders. However, few large-scale studies from South Asia have examined long-term ERCP outcomes, particularly using established quality benchmarks.

AIM: To evaluate ERCP indications, success rates, complications, and quality performance at a high-volume tertiary care center in Pakistan over a 17-year period.

METHODS

This retrospective study analyzed 13215 ERCP procedures performed between 2006 and 2023. Data included demographics, indications, cannulation rates, complications, and pediatric cases. Findings were assessed against American Society of Gastroenterology/European Society of Gastrointestinal Endoscopy quality indicators.

RESULTS

Biliary ERCP accounted for 93.1% of procedures; choledocholithiasis was the most common indication (40%). Cannulation success was 93.9% for biliary and 94.2% for pancreatic ERCP. Pediatric ERCP comprised 4% of cases, mostly for stones and chronic pancreatitis. Bleeding (1.7%) and post-ERCP pancreatitis (2.3%) were the most frequent complications. Performance met or exceeded most American Society of Benchmarks.

CONCLUSION

This study offers insight into nearly two decades of ERCP practice within a public sector hospital. Our experience echoes the quality and efficiency of ERCP not previously available in Pakistan. As healthcare systems in resource-limited sectors expand, our findings serve as a reference point. Continued training and quality improvement studies can further enhance ERCP effectiveness in the region and beyond.