Objective To explore the clinical application value of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of chronic pancreatitis and its complications in adolescents. Methods The clinical data of 104 adolescent patients with chronic pancreatitis and complications who were admitted to the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2023 to December 2024 were collected and a retrospective analysis was conducted. The patients were divided into the ERCP group (receiving ERCP treatment) and the control group (receiving conventional treatment) based on the treatment methods. The treatment effects, safety indicators, recurrence rates within six months, and scores of quality of life were compared between the two groups. Results There were 68 cases in the ERCP group and 36 cases in the control group. The two groups showed no significant differences in age, disease characteristics, and pre-treatment visual analogue scale (VAS) scores (P=0.080, 0.386, and 0.185, respectively), while the difference in 12-item short form health survey (SF-12) scores before treatment were significant (P=0.025). Before treatment, the VAS scores of the two groups were 6.63±1.74 and 6.26±1.08, respectively (P>0.05). After treatment, the VAS score in the ERCP group (2.57±0.64) was significantly lower than that in the control group (4.63±0.79) (P<0.001). Before treatment, the SF-12 scores of the two groups were 44.57±8.09 and 49.36±11.02, respectively (P>0.05); after treatment, the SF-12 score in the ERCP group (84.65±9.27) was significantly higher than that in the control group (69.16±7.75) (P<0.001). In addition, the recurrence rates within six months were 14.08% (ERCP group) and 36.11% (control group), and complication rates were 1.47% (ERCP group) and 8.33% (control group), which showed significant differences. Conclusions For adolescent patients with cholangiopancreatography and its complications, ERCP (especially pancreatic duct stone removal and stent placement) effectively alleviates clinical symptoms, improves quality of life, and shows high success rates with a low incidence of complications.