Harnessing early enzymatic biomarkers and cytokines for risk prediction in post-endoscopic retrograde cholangiopancreatography pancreatitis

Abstract

This editorial critically analyses the recent article by Jung et al, which investigates the utility of 4-hour serum amylase and lipase as early blood markers for post-endoscopic retrograde cholangiopancreatography (ERCP) acute pancreatitis prediction. Although these enzymes are valuable for the early diagnosis of post-ERCP pancreatitis, they lack specificity for disease etiology and provide limited insight into the molecular mechanisms underlying disease progression. Several cytokines, notably interleukin (IL)-6, tumor necrosis factor-alpha, and IL-8, are increased in post-ERCP pancreatitis and may serve as potential predictors for disease severity. The incorporation of these biomarkers in early enzymatic biomarkers and established prognostic scoring systems could further enhance their accuracy and allow for earlier, more effective management of patients with post-ERCP pancreatitis.

Keywords: Cytokines; Enzymatic biomarkers; Post-endoscopic retrograde cholangiopancreatography pancreatitis; Early diagnosis; Prognosis

Core Tip: Although high serum 4-hour amylase and lipase levels enable early diagnosis of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, they have limited prognostic value and lack etiological specificity. Interleukin (IL)-6 has emerged as an early inflammatory biomarker for predicting post-ERCP pancreatitis severity. However, detection and quantification of this cytokine remain costly. Validation of rapid, cost-effective, and point-of-care IL-6 immunoassays is essential for their integration into routine clinical practice for post-ERCP pancreatitis risk prediction.