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Publication Name
World Journal of Gastrointestinal Surgery
ISSN
1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Meta-Analysis
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. Nov 27, 2026; 18(11): 124443
Published online Nov 27, 2026. doi: 10.4240/wjgs.124443
Preventive strategies for post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review and meta-analysis
Xiao-Yan Wang, Yi-Yi Liu, Yan-Feng Zhang, Xiao-Qin Zhou, Meng-Chen Sun, Qin Zheng
Xiao-Yan Wang, Yan-Feng Zhang, Xiao-Qin Zhou, Department of Interventional Radiology, Eastern Hepatobiliary Surgery Hospital, Shanghai 201805, China
Yi-Yi Liu, Department of Gastroenterology, Eastern Hepatobiliary Surgery Hospital, Shanghai 201805, China
Meng-Chen Sun, Department of Hepatobiliary and Pancreatic Surgery, Shanghai East Hospital, Shanghai 200120, China
Qin Zheng, Department of Nursing, Eastern Hepatobiliary Surgery Hospital, Shanghai 201805, China
Co-first authors: Xiao-Yan Wang and Yi-Yi Liu.
Co-corresponding authors: Meng-Chen Sun and Qin Zheng.
Author contributions: Wang XY and Liu YY contributed to the conceptualization of the study, study design, literature search, study selection, and data extraction; both authors contributed equally to this article and are the co-first authors of this manuscript; Wang XY performed statistical analysis and data interpretation; Liu YY conducted risk-of-bias assessment and Grading of Recommendations Assessment, Development and Evaluation evidence evaluation; Zhang YF and Zhou XQ undertook drafting of the original manuscript as well as table and figure preparation and manuscript formatting; Sun MC and Zheng Q were responsible for critical revision of the manuscript for important intellectual content, supervision, and final approval of the version to be published, both contributed equally to this article, and are the co-corresponding authors of this manuscript; all authors read and approved the final manuscript.
AI contribution statement: During the preparation of this manuscript, AI-assisted language editing tools (including large language models such as ChatGPT and DeepSeek) were used solely for preliminary grammar correction, syntactic refinement, and vocabulary enhancement to improve the readability of the text. Following this initial AI-assisted editing, the entire manuscript underwent comprehensive professional language polishing by a certified commercial English-language editing service (certificate of editing is available upon request). Crucially, no AI tools or software were used to generate original scientific data, perform statistical analyses, conduct the systematic literature search, extract study data, interpret the pooled results, or draw any scientific conclusions. All AI-assisted outputs, as well as the final edited version, were rigorously reviewed, fact-checked, and approved by all authors. The authors assume full responsibility and accountability for the integrity, accuracy, originality, and scientific validity of all content presented in this manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Qin Zheng, Associate Chief Nurse, Department of Nursing, Eastern Hepatobiliary Surgery Hospital, No. 700 Mobei North Road, Jiading District, Shanghai 201805, China. sui0743@sina.com
Received: July 8, 2026
Revised: August 6, 2026
Accepted: October 9, 2026
Published online: November 27, 2026
Processing time: 146 Days and 21.3 Hours
Abstract
BACKGROUND

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a common and clinically significant adverse event following ERCP. Although pharmacological and endoscopic prophylactic measures have been widely investigated, the implications of these strategies for perioperative nursing pathways require systematic synthesis.

AIM

To investigate the effects of preventive strategies on the risk of PEP and summarize the clinical implications for standardized perioperative nursing practice.

METHODS

Chinese and international databases, including the China National Knowledge Infrastructure, Wanfang, the VIP Database for Chinese Technical Periodicals, the China Biology Medicine disc, the Chinese Clinical Trial Registry, PubMed, Web of Science, and the Cochrane Library, were searched from January 2016 to February 2026. Randomized controlled trials comparing preventive interventions with conventional care, placebo, blank control, or routine treatment in adult patients undergoing therapeutic ERCP and reporting PEP events were considered eligible. Risk ratios with 95% confidence intervals were pooled using Review Manager 5.4.1. Heterogeneity was evaluated using the χ2 test and the I2 statistic.

RESULTS

Fourteen randomized controlled trials involving 4788 participants were included. PEP occurred in 93 of 2374 patients in the intervention groups and 249 of 2414 patients in the control groups. Preventive strategies significantly reduced the risk of PEP compared with control conditions (risk ratio = 0.38, 95% confidence interval: 0.30-0.48, P < 0.00001), with no statistically significant heterogeneity (I2 = 0%, P = 0.77). Most included interventions involved pharmacological prophylaxis, primarily non-steroidal anti-inflammatory drug-based regimens, or prophylactic pancreatic duct stenting. Risk-of-bias assessment revealed common limitations related to blinding, allocation concealment, and reporting of outcome assessment procedures.

CONCLUSION

Current evidence supports the implementation of structured perioperative nursing pathways for PEP prevention through risk screening, timely care coordination, close monitoring, and patient education.

Keywords: Endoscopic retrograde cholangiopancreatography; Post-endoscopic retrograde cholangiopancreatography pancreatitis; Prevention; Nursing; Non-steroidal anti-inflammatory drugs; Pancreatic duct stent; Meta-analysis

Core Tip: Preventive strategies, primarily non-steroidal anti-inflammatory drug-based pharmacological prophylaxis and pancreatic duct stenting, reduce the risk of post-ERCP pancreatitis by 62% (risk ratio = 0.38, 95% confidence interval: 0.30-0.48). Structured perioperative nursing pathways integrating risk screening, timely prophylaxis coordination, close postprocedural monitoring, and patient education are essential to translate this evidence into consistent clinical practice and improved patient safety.
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