Zakaria N, Tahseen MU, Niaz TS, Asim M, Yaseen A, Kadir S, Qureshi S, Ghazanfar S, Leghari A, Taj MA, Siddiqui AR, Altaf A, Ahmed N, Raza A, Salman J, Shoaib UB, Siyal M, Durvesh AK, Niaz SK. Endoscopic retrograde cholangiopancreatography in pediatric and adult populations: 17-year experience from Pakistan with trends, complications, and global comparison. World J Gastrointest Endosc 2025; 17(11): 109909 [PMID: 41256309 DOI: 10.4253/wjge.v17.i11.109909]
Corresponding Author of This Article
Shanil Kadir, PhD, Assistant Professor, Consultant, FRCP, Department of Gastroenterology, Sindh Institute of Advanced Endoscopy and Gastroenterology, Heritage Building, Dr Ruth K.M. Pfau Civil Hospital, Karachi 75000, Sindh, Pakistan. shanildr@yahoo.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 16, 2025 (publication date) through Dec 12, 2025
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Publication Name
World Journal of Gastrointestinal Endoscopy
ISSN
1948-5190
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Zakaria N, Tahseen MU, Niaz TS, Asim M, Yaseen A, Kadir S, Qureshi S, Ghazanfar S, Leghari A, Taj MA, Siddiqui AR, Altaf A, Ahmed N, Raza A, Salman J, Shoaib UB, Siyal M, Durvesh AK, Niaz SK. Endoscopic retrograde cholangiopancreatography in pediatric and adult populations: 17-year experience from Pakistan with trends, complications, and global comparison. World J Gastrointest Endosc 2025; 17(11): 109909 [PMID: 41256309 DOI: 10.4253/wjge.v17.i11.109909]
World J Gastrointest Endosc. Nov 16, 2025; 17(11): 109909 Published online Nov 16, 2025. doi: 10.4253/wjge.v17.i11.109909
Endoscopic retrograde cholangiopancreatography in pediatric and adult populations: 17-year experience from Pakistan with trends, complications, and global comparison
Noval Zakaria, Muhammad U Tahseen, Talha S Niaz, Muhammad Asim, Asma Yaseen, Shanil Kadir, Sajida Qureshi, Shahriyar Ghazanfar, Aftab Leghari, Muhammad A Taj, Arif R Siddiqui, Abeer Altaf, Naseer Ahmed, Areeba Raza, Javeria Salman, Umer B Shoaib, Mehreen Siyal, Abdul K Durvesh, Saad K Niaz
Noval Zakaria, Muhammad U Tahseen, Muhammad Asim, Asma Yaseen, Shanil Kadir, Sajida Qureshi, Shahriyar Ghazanfar, Aftab Leghari, Muhammad A Taj, Arif R Siddiqui, Abeer Altaf, Naseer Ahmed, Areeba Raza, Javeria Salman, Umer B Shoaib, Mehreen Siyal, Abdul K Durvesh, Saad K Niaz, Department of Gastroenterology, Sindh Institute of Advanced Endoscopy and Gastroenterology, Karachi 75000, Sindh, Pakistan
Talha S Niaz, Department of Gastroenterology, Darent Valley Hospital, Dartford DA2 8DA, Kent, United Kingdom
Co-first authors: Noval Zakaria and Muhammad U Tahseen.
Author contributions: Zakaria N designed the report and supervised the project; Tahseen MU and Niaz TS collected the patients’ clinical data; Asim M and Yaseen A performed the data analysis; Kadir S and Qureshi S contributed to the literature review and interpretation of findings; Ghazanfar S and Laghari A contributed to data visualization and formatting; Taj MA and Siddiqui A revised the manuscript critically for important intellectual content; Altaf A and Ahmed N coordinated ethical approvals and institutional communication; Raza A and Salman J assisted in drafting the manuscript; Shoaib UB, Siyal M, Durvesh AK, and Niaz SK finalized the manuscript for submission. Zakaria N and Tahseen MU contributed equally to this manuscript and are co-first authors. All authors reviewed and approved the final version of the manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of the Dow University of Health Sciences (Approval No: IRB-2222/DUHS/EXEMPTION/2021/339).
Informed consent statement: As this was a retrospective study using anonymized patient data, informed consent was waived by the Institutional Review Board.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shanil Kadir, PhD, Assistant Professor, Consultant, FRCP, Department of Gastroenterology, Sindh Institute of Advanced Endoscopy and Gastroenterology, Heritage Building, Dr Ruth K.M. Pfau Civil Hospital, Karachi 75000, Sindh, Pakistan. shanildr@yahoo.com
Received: June 10, 2025 Revised: July 4, 2025 Accepted: October 10, 2025 Published online: November 16, 2025 Processing time: 160 Days and 3.8 Hours
Abstract
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.
Core Tip: We performed a retrospective analysis of 13215 endoscopic retrograde cholangiopancreatography (ERCP) procedures at a single tertiary care hospital in Karachi, Pakistan. We aimed to identify the quality, safety, and efficacy of ERCP in South Asia. The findings demonstrated the dependability of ERCP in a resource-constrained environment with excellent cannulation success rates (over 93%) and a low incidence of significant problems. The findings highlighted the critical need to increase ERCP access and specialized training throughout the region to improve outcomes for individuals with pancreatobiliary illnesses.
