Xu PW, Xu QQ, Yu Y, Jiao Y, Liu YH, Yang L. Risk factors and prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. World J Gastrointest Endosc 2026; 18(3): 115736 [DOI: 10.4253/wjge.v18.i3.115736]
Corresponding Author of This Article
Ya-Hui Liu, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun 130000, Jilin Province, China. yahui@jlu.edu.cn
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Gastroenterology & Hepatology
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Mar 16, 2026 (publication date) through Mar 18, 2026
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World Journal of Gastrointestinal Endoscopy
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Xu PW, Xu QQ, Yu Y, Jiao Y, Liu YH, Yang L. Risk factors and prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. World J Gastrointest Endosc 2026; 18(3): 115736 [DOI: 10.4253/wjge.v18.i3.115736]
World J Gastrointest Endosc. Mar 16, 2026; 18(3): 115736 Published online Mar 16, 2026. doi: 10.4253/wjge.v18.i3.115736
Risk factors and prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis
Pei-Wen Xu, Qian-Qian Xu, Yan Yu, Yan Jiao, Ya-Hui Liu, Lei Yang
Pei-Wen Xu, Lei Yang, Endoscopic Center, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
Qian-Qian Xu, Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
Yan Yu, Department of The First Operation Room, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
Yan Jiao, Ya-Hui Liu, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
Co-corresponding authors: Ya-Hui Liu and Lei Yang.
Author contributions: Liu YH, Xu PW and Yang L revised the manuscript; Xu PW and Yang L contributed critically to figure design, playing key roles in refining the scientific clarity and visual presentation of the review; Xu QQ contributed to the conceptualization, literature review, and initial drafting of the manuscript; Yu Y was responsible for data collection and provided important intellectual revisions; Jiao Y conceived and supervised the study; Liu YH and Yang L contributed equally to this manuscript and are co-corresponding authors.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Ya-Hui Liu, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun 130000, Jilin Province, China. yahui@jlu.edu.cn
Received: October 24, 2025 Revised: November 28, 2025 Accepted: January 20, 2026 Published online: March 16, 2026 Processing time: 140 Days and 20.8 Hours
Abstract
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common and serious complication following ERCP, with incidence rates ranging from 3% to 15% and up to 40% in high-risk patients. Its multifactorial pathogenesis involves both patient-related and procedure-related factors. Established risk factors include female sex, younger age, sphincter of Oddi dysfunction, previous pancreatitis, difficult cannulation, and pancreatic duct injection. The combination of several risk factors markedly increases the likelihood of PEP, underscoring the need for individualized risk assessment. Preventive strategies have evolved from empirical approaches to evidence-based interventions. Rectal non-steroidal anti-inflammatory drugs and prophylactic pancreatic duct stenting are strongly supported by clinical evidence as effective measures, particularly in high-risk patients. Aggressive intravenous hydration and early precut sphincterotomy have also shown benefit. However, the efficacy of pharmacological agents such as somatostatin, gabexate, and nafamostat mesilate remains inconsistent. Recent advances include the development of risk prediction models and scoring systems that integrate patient and procedural variables, offering moderate predictive accuracy. Ongoing research explores the use of artificial intelligence to improve risk stratification and guide prophylactic strategies. Future efforts should focus on standardizing diagnostic criteria, validating predictive tools, and optimizing combined preventive protocols. Through integrated risk assessment and tailored prevention, the incidence and severity of PEP may be significantly reduced, improving safety and outcomes in ERCP practice.
Core Tip: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis remains the most frequent and severe complication of ERCP, arising from the interplay of patient and procedural risk factors. Key predictors include female sex, younger age, sphincter of Oddi dysfunction, difficult cannulation, and pancreatic duct manipulation. Evidence strongly supports rectal non-steroidal anti-inflammatory drugs, prophylactic pancreatic duct stenting, and aggressive intravenous hydration as effective preventive measures, particularly in high-risk patients. Recent advances in risk prediction models and artificial intelligence-driven analytics offer opportunities for individualized risk assessment and tailored prophylaxis, which may markedly reduce post-ERCP pancreatitis incidence and improve procedural safety.
