Dachengqitang mitigates endoscopic retrograde cholangiopancreatography-induced pancreatitis

doi:10.4240/wjgs.v18.i3.112405

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Mar 27, 2026 (publication date) through Mar 30, 2026

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Mar 27, 2026; 18(3): 112405
Published online Mar 27, 2026. doi: 10.4240/wjgs.v18.i3.112405

Dachengqitang mitigates endoscopic retrograde cholangiopancreatography-induced pancreatitis

Lei Zheng, Jin Wang, Mao-Qi Xu, Wen Jiang, Long Qian, Yu Ge, Mao-Kun Feng, Yi-Mei Zhu, Meng-Jun Wang, Sha-Sha Sun, Chang-Kuo Liu, Xiao-Ming Wang, Chao Zhang

Lei Zheng, Jin Wang, Xiao-Ming Wang, The Fifth Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China

Lei Zheng, Jin Wang, Mao-Qi Xu, Wen Jiang, Long Qian, Yu Ge, Mao-Kun Feng, Yi-Mei Zhu, Meng-Jun Wang, Sha-Sha Sun, Chang-Kuo Liu, The Third Department of Surgery, Wuhu Traditional Chinese Medicine Hospital Affiliated to Anhui College of Traditional Chinese Medicine, Wuhu 241000, Anhui Province, China

Xiao-Ming Wang, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, China

Chao Zhang, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China

Co-first authors: Lei Zheng and Jin Wang.

Co-corresponding authors: Xiao-Ming Wang and Chao Zhang.

Author contributions: Zheng L and Wang J conceptualization, methodology, investigation, data curation, formal analysis, and writing-original draft; Xu MQ, Jiang W, Qian L, Ge Y, Feng MK, Zhu YM, Wang MJ, and Sun SS data collection, experimental operation, and validation; Liu CK resources, data supervision, and technical support; Wang XM and Zhang C supervision, project administration, conceptualization, funding acquisition, and writing-review and editing. All authors have read and approved the final manuscript. Zheng L and Wang J contributed equally to this work as co-first authors. This study designates Wang XM and Zhang C as co-corresponding authors based on the following considerations. First, this research involves the integration of traditional Chinese medicine and modern medicine. Wang XM, from the Department of Hepatobiliary Surgery at the First Affiliated Hospital of Wannan Medical College, possesses extensive experience in the clinical diagnosis, treatment, and basic research of ERCP-related pancreatitis. He was responsible for the overall study design, surgical technical guidance, and clinical translation direction. Zhang C, from the Department of Hepatobiliary Surgery at the First Affiliated Hospital of Anhui Medical University, has profound expertise in the molecular mechanism research of hepatobiliary and pancreatic diseases. He was primarily responsible for the molecular biology experimental design, data analysis, and mechanism interpretation. Second, the two corresponding authors rely on different research platforms and academic resources, forming complementary advantages. Wang XM focuses on clinical application research, while Zhang C emphasizes basic mechanism exploration. Their collaborative efforts ensure a complete research loop that originates from clinical problems, is supported by basic research, and ultimately returns to clinical application. Furthermore, this study involves multi-center and multi-disciplinary collaboration. Both professors serve as principal investigators at their respective institutions. The designation of co-corresponding authors facilitates clear attribution of academic responsibilities and promotes the continued in-depth development of subsequent research.

Supported by Natural Science Research Project of Higher Education Institution of Anhui Provincial Department of Education, No. 2022AH052638 and No. 2023AH040254.

Institutional review board statement: The study protocol was reviewed and approved by the Medical Ethics Committee of Wuhu Traditional Chinese Medicine Hospital (Approval No. YW-2022-077).

Institutional animal care and use committee statement: All animal experimental procedures were conducted in accordance with the Guide for the Care and Use of Laboratory Animals and approved by the Medical Ethics Committee of Wuhu Traditional Chinese Medicine Hospital (Approval No. YW-2022-077).

Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to this study.

ARRIVE guidelines statement: The authors have read the ARRIVE guidelines, and the manuscript was prepared and revised according to the ARRIVE guidelines.

Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Corresponding author: Xiao-Ming Wang, MD, PhD, The Fifth Clinical Medical College, Anhui Medical University, No. 240 Jiuhua Middle Road, Jinghu District, Wuhu 230032, Anhui Province, China. wxm6901@126.com

Received: September 12, 2025
Revised: October 28, 2025
Accepted: December 12, 2025
Published online: March 27, 2026
Processing time: 196 Days and 4.7 Hours

Abstract

BACKGROUND

Post-endoscopic retrograde cholangiopancreatography (ERCP) acute pancreatitis (PEP) is a severe postoperative inflammatory complication following ERCP, characterized by rapid onset and potentially life-threatening systemic manifestations. The integrity of the intestinal mucosal barrier plays a pivotal role in preventing secondary infections and systemic inflammatory response syndrome in the postoperative period. Traditional Chinese medicine has shown promising therapeutic potential in postoperative management and mucosal barrier protection.

AIM

To investigate the efficacy of Dachengqitang (DCQT) in ameliorating PEP through enhancement of intestinal mucosal barrier function and suppression of M1 macrophage polarization.

METHODS

Bioinformatics analysis was performed on differential gene expression and functional enrichment using the GEO database entry GSE54774. Subsequently, in vivo and in vitro experiments were conducted, including sham operation group, PEP model group, and DCQT + PEP model group, to evaluate intestinal mucosal integrity, inflammatory markers, and macrophage activation in the postoperative setting.

RESULTS

Differential analysis of GSE54774 identified 468 differentially expressed genes, with enrichment observed in blood microparticle, primary lysosome, and azurophil granule pathways. In vivo experiments demonstrated that compared to the PEP model group, DCQT treatment significantly enhanced the expression of intestinal mucosal barrier proteins ZO-1 and Occludin-1, reduced the population of CD86-positive pro-inflammatory macrophages, and promoted IL-10 secretion by M2 macrophages in the postoperative period. In vitro Caco-2 cell cultures showed that compared to the oxygen-glucose deprivation group, DCQT improved ZO-1 and Occludin-1 expression and enhanced mitochondrial membrane potential.

CONCLUSION

This study demonstrates that DCQT effectively enhances intestinal mucosal barrier function and reduces postoperative intestinal inflammation following ERCP-induced pancreatic inflammation, suggesting its potential as a postoperative therapeutic intervention for PEP management.

Keywords: Dachengqitang; Post-endoscopic retrograde cholangiopancreatography acute pancreatitis; Postoperative complications; Intestinal mucosal barrier; M1 macrophages; Inflammation

Core Tip: Post-endoscopic retrograde cholangiopancreatography (ERCP) acute pancreatitis is a serious complication involving intestinal mucosal barrier dysfunction and excessive inflammation. This study integrates bioinformatics analysis with in vivo and in vitro models to investigate the protective effects of Dachengqitang (DCQT). The results demonstrate that DCQT enhances intestinal barrier integrity by upregulating ZO-1 and Occludin-1, reduces M1 macrophage activation, and promotes M2 polarization with increased IL-10 expression. DCQT also improves mitochondrial membrane potential in epithelial cells. These findings highlight the therapeutic potential of DCQT in managing postoperative inflammatory responses following ERCP.