Abstract：AIMS: To discuss the indications, complications and risk factors of Endoscopic retrograde cholangiopancreatography (ERCP) in children with biliary system and pancreatic diseases. METHODS We picked 61 pediatric patients, both under 14 years old, who was admitted in Beijing Friendship Hospital Endoscopy Center from 2010 to 2017 to treat their biliary and/or pancreatic diseases with Endoscopic retrograde cholangiopancreatography (ERCP). Throughout the treatment, 101 times of ERCP was operated. We will analyze the indication, anesthesia method, success rate and incidence of complications of these cases retrospectively, and will initially analyze the risk factors of complications. RESULTS Within a total 101 Endoscopic retrograde cholangiopancreatography (ERCP) operations of 61 children, a success rate of 96% (4/101) was achieved. Chronic pancreatitis (69 cases), pancreatic divisum (12 cases) and bile duct stones (9 cases) are the top three indications. 32% (33/101) got complications, which most commonly be seen are hyperamylase and postoperative pancreatitis. There is no significant difference in the incidence of operative complications between pancreatic disease and biliary tract disease. Chronic pancreatitis is negatively corelated with post-ERCP pancreatitis and hyperamylase. Pancreatic divisum and pancreatic duct intubation are risk factors of postoperative pancreatitis and hyperamylase after ERCP. CONCLUSION Chronic pancreatitis is the main indication of ERCP in children with cholangiopancreatic diseases. The success rate of ERCP in children is relatively high, and the incidence of related complications is not low, which should be paid attention to in the operation of some special patients (such as patients with pancreatic divisum).