Post-endoscopic retrograde cholangiopancreatography pancreatitis: Mechanistic pathways, diagnostic benchmarks, and emerging and mitochondria-targeted therapies

Table 3 The risk stratification model for post-endoscopic retrograde cholangiopancreatography pancreatitis

Risk factors included	Predictive value	Advantages and disadvantages	Ref.
Pain; pancreatic duct cannulation; previous PEP; and the number of cannulation attempts	Low-risk: 1.9%; medium-risk: 6.9% and high-risk: 28%	Applicable to patients suspected of having SOD and those at high risk for PEP; not validated; a pioneer in the risk stratification model for PEP	Friedland et al[92], 2002
History of gastrectomy; high DBIL; high ALB; CBD stones; papillary opening with villous type; papillary opening with nodular type; pancreatic guidewire passage; pre-cut sphincterotomy; and high procedural experience	Low-risk: 6.1%; medium-risk, 17%; high-risk: 37.5%. AUC was 0.718–0.793; sensitivity was 0.705–0.727; and specificity was 0.676–0.797	Applicable to patients suspected of having SOD and those at high risk for PEP; not validated; a pioneer in the risk stratification model for PEP	Zheng et al[95], 2020
Complete papilla; PGW-assisted biliary cannulation; difficult cannulation; pancreatic injection; absence of a pancreatic stent	Extremely high-risk: 28.79%; the predicted incidence of severe pancreatitis was 9.09%. AUC was 0.86, while the AUC for internal validation was 0.81	Applicable to patients suspected of having SOD and those at high risk for PEP; not validated; a pioneer in the risk stratification model for PEP	Chiba et al[97], 2021
A history of PEP; complete papilla; difficult cannulation; pancreatic guidewire-assisted biliary cannulation; pancreatic injection; IDUS/sampling of the pancreas; biliary IDUS/sampling	The AUC in both the training and validation sets were 0.799 and 0.791, respectively; In the high-risk, the incidence of PEP was 13.4%	Applicable to patients suspected of having SOD and those at high risk for PEP; not validated; a pioneer in the risk stratification model for PEP	Fujita et al[4], 2022
Age ≤ 65 years; female sex; history of acute pancreatitis; malignant biliary obstruction	Low risk: 2.2%; medium risk: 3.8%; high risk: 6.9%	Pre-ERCP risk prediction model	Kim et al[81], 2022
Age ≤ 65 years; female sex; history of acute pancreatitis; malignant biliary obstruction; pancreatic sphincterotomy	Low risk: 2.0%; medium risk: 3.4%; high risk: 18.4%	Post-ERCP risk prediction model; the model based on retrospective data, its reliability in practical application remains uncertain	Kim et al[81], 2022
Extended total operation time; unexpected pancreatic duct cannulation; pancreatic imaging total operation time; unexpected pancreatic duct cannulation; and pancreatic imaging	Low-risk, medium-risk, and high-risk were 2.6%, 7.1%, and 12.6%, respectively	Using prospective cohort data; indicated that most patients without PEP had an operation time of less than 14 minutes	Kim et al[81], 2022
Female gender; pancreatic duct cannulation; papillary condition; pre-cut sphincterotomy; prolonged cannulation time; bile duct stenosis; patient age; pancreatic duct stent placement	An ROC curve statistic of 0.79; a predicted-to-observed risk ratio of 1.003	Has good discriminative ability and good calibration	Meng et al[98], 2024

SOD: Sphincter of Oddi dysfunction; PEP: Post-endoscopic retrograde cholangiopancreatography pancreatitis; DBIL: Direct bilirubin; ALB: Albumin; CBD: Common bile duct; AUC: Area under the curve; PGW: Pancreatic guide-wire; IDUS: Intraductal ultrasound; ROC: Receiver operating characteristic.