ObjectiveTo summarize the clinical characteristics and evaluate the long-term outcomes of endoscopic retrograde cholangiopancreatography (ERCP) therapy in patients with pancreatic divisum (PD)-associated pancreatitis (PDAP). MethodsClinical data of patients diagnosed with PDAP at West China Hospital of Sichuan University from June 2011 to June 2024 were retrospectively collected. The pancreatitis remission rate at the last follow-up, the incidence of post-ERCP pancreatitis and the cannulation failure rate were calculated. ResultsA total of 65 patients were enrolled, with an age of (44±17) years. Thirty-four (52.3%) patients were diagnosed with chronic pancreatitis, and 31 (47.7%) patients had recurrent acute pancreatitis (RAP). In terms of PD classification, incomplete-type PD was identified in 38 (58.5%) patients, complete-type PD in 24 (36.9%) patients, and classification data were unavailable for the remaining 3 (4.6%) patients. Patients with complete-type PD were diagnosed at a significantly younger age than those with incomplete-type PD [(37±18) years vs. (48±15) years, P=0.014], and no other baseline characteristics differed significantly between the two groups (P>0.05). ERCP was performed in 58 (89.2%) patients, the cannulation failure rate was 12.1% (7/58). Major papilla cannulation failed in all patients with complete-type PD. Post-ERCP pancreatitis occurred in 22.4% (13/58), with no severe adverse events (e.g., massive hemorrhage or perforation). After excluding 2 patients lost to follow-up, valid data were available for 56 patients (follow-up rate: 96.6%). The overall remission rate was 62.5% (35/56). Compared with the achieved clinical improvement, the proportion of the patients with RAP was lower [19.0% (4/21) vs. 54.3% (19/35), P=0.009], ERCP failure rate was higher [28.6% (6/21) vs. 2.9% (1/35), P=0.009], pancreatic stent placement ratio was lower [57.1% (12/21) vs. 85.7% (30/35), P=0.017] in the patients with non-achieved clinical improvement. No statistically significant differences were found in other baseline characteristics between the two groups (P>0.05). ConclusionsThese findings suggest that therapeutic ERCP is both feasible and efficacious for PDAP. Furthermore, patients with PD-related RAP might achieve better outcomes than those with chronic pancreatitis, indicating a potential phenotype-specific response to endoscopic therapy.