Risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis in the Chinese population: a systematic review and meta-analysis

Abstract

Aim: To systematically identify and evaluate key risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis in the Chinese population, providing evidence-based guidance to inform clinical practice, particularly strategies for prevention.

Methods: A comprehensive literature search was conducted across PubMed, China National Knowledge Infrastructure, and other databases from October 2003 to October 2023. Data from 38 rigorously appraised investigations - comprising randomized controlled trials, case-control analyses, and cohort studies - were synthesized in RevMan 5.3 using both fixed- and random-effects models as appropriate. Risk factors were evaluated using odds ratios (ORs) with 95% confidence intervals (CIs), adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: The meta-analysis identified 22 significant risk factors. The strongest predictors included prior post-ERCP pancreatitis (OR = 6.56, 95%CI: 2.40-17.92), duodenal papillary abnormalities (OR = 3.38, 95%CI: 1.41-8.08), and difficult cannulation (OR = 3.39, 95%CI: 2.07-5.54). Other notable factors were endoscopic papillary balloon dilation (OR = 2.75, 95%CI: 1.61-4.72), elevated superoxide dismutase (SOD) levels (OR = 2.81, 95%CI: 1.24-6.34), female gender (OR = 2.77, 95%CI: 2.00-3.82), and prolonged cannulation time (OR = 2.05, 95%CI: 1.18-3.57). In contrast, hypertension (OR = 1.93, 95%CI: 0.78-4.78) and biliary stenting (OR = 1.65, 95%CI: 0.41-6.58) were not significantly associated with ERCP.

Conclusion: Procedural, anatomical, and biochemical factors were significantly associated with increased post-ERCP pancreatitis risk in Chinese patients. Early identification of high-risk individuals, especially those with prior pancreatitis or papillary abnormalities, and tailored interventions are critical for reducing incidence. These findings provide an evidence-based framework to enhance clinical outcomes in ERCP procedures.

Keywords

Endoscopic retrograde cholangiopancreatography / pancreatitis / risk factors / meta-analysis / Chinese population

References

[1] Drabek J,Stovicek J.The role of endoscopic retrograde cholangiopancreatography in choledochal cysts and/or abnormal pancreatobiliary junction in children.Prz Gastroenterol2017;12:303-9 PMCID:PMC5771456

[2] Aydelotte JD,Huynh PT,Uecker JM.Use of magnetic resonance cholangiopancreatography in clinical practice: not as good as we once thought.J Am Coll Surg2015;221:215-9

[3] Hu LH,Liao Z.Endoscopy Audit of the Chinese Society of Digestive EndoscopyERCP development in the largest developing country: a national survey from China in 2013.Gastrointest Endosc2016;84:659-66

[4] Akshintala VS,Bhullar FA.Incidence, severity, and mortality of post-ERCP pancreatitis: an updated systematic review and meta-analysis of 145 randomized controlled trials.Gastrointest Endosc2023;98:1-6.e12

[5] Freeman ML,Sherman S.Complications of endoscopic biliary sphincterotomy.N Engl J Med1996;335:909-18

[6] Tryliskyy Y.Post-ERCP pancreatitis: pathophysiology, early identification and risk stratification.Adv Clin Exp Med2018;27:149-54

[7] Elmunzer BJ.Reducing the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis.Dig Endosc2017;29:749-57

[8] Morales SJ,Gardner TB.A review of prevention of post-ERCP pancreatitis.Gastroenterol Hepatol2018;14:286-92 PMCID:PMC6034611

[9] Kochar B,Afghani E.Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials.Gastrointest Endosc2015;81:143-9.e9

[10] Alsakarneh S,Ahmed K.Incidence and cross-continents differences in endoscopic retrograde cholangiopancreatography outcomes among patients with cirrhosis: a systematic review and meta-analysis.Gastroenterology Res2023;16:105-17 PMCID:PMC10181340

[11] Syrén EL,Enochsson L.Outcome of ERCP related to case-volume.Surg Endosc2022;36:5339-47 PMCID:PMC9160106

[12] Sperna Weiland CJ, Engels MML, Poen AC, et al; Dutch Pancreatitis Study Group. Increased use of prophylactic measures in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis.Dig Dis Sci2021;66:4457-66 PMCID:PMC8589790

[13] Xu Y,Wang D.Meta-analysis on the efficacy and safety of traditional Chinese medicine in preventing post-ERCP pancreatitis.J Hexi Univ2021;37:20-28

[14] Ergin E,Ersöz G,Özütemiz Ö.Prognosis and risk factors of ERCP pancreatitis in elderly.Sci Rep2021;11:15930 PMCID:PMC8342449

[15] Pekgöz M.Post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review for prevention and treatment.World J Gastroenterol2019;25:4019-42 PMCID:PMC6689803

[16] Wen K,Wu L.Relationship between pancreatic parenchyma loss and early postoperative hyperglycemia in patients with benign pancreatic diseases.Abdom Radiol2021;46:4210-7 PMCID:PMC8346412

[17] García-Cano J.Should we administer rectal anti-inflammatory drugs in all ERCPs in order to prevent pancreatitis?.Rev Esp Enferm Dig2020;112:167-9

[18] Akashi R,Tanaka T,Oda Y.Mechanism of pancreatitis caused by ERCP.Gastrointest Endosc2002;55:50-4

[19] Cui PJ,Zhao YJ,Yang J.Biliary stenting with or without sphincterotomy for malignant biliary obstruction: a meta-analysis.World J Gastroenterol2014;20:14033-9 PMCID:PMC4194589

[20] Zhang D,Li L,Liu F.Radiocontrast agent and intraductal pressure promote the progression of post-ERCP pancreatitis by regulating inflammatory response, cellular apoptosis, and tight junction integrity.Pancreatology2022;22:74-82

[21] Shin SH,Cho S.The number of wire placement in the pancreatic duct and metal biliary stent as risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis.J Gastroenterol Hepatol2020;35:1201-7

[22] Wen L,Yimlamai D,Xiao X.Transient high pressure in pancreatic ducts promotes inflammation and alters tight junctions via calcineurin signaling in mice.Gastroenterology2018;155:1250-63.e5 PMCID:PMC6174093

[23] Chi JY,Zou JC.Risk factors of pancreatitis after endoscopic retrograde cholangiopancreatography in patients with biliary tract diseases.BMC Surg2023;23:62 PMCID:PMC10037844

[24] Concepción-Martín M,Juanes A.Somatostatin for prevention of post-ERCP pancreatitis: a randomized, double-blind trial.Endoscopy2014;46:851-6

[25] Zhu P.Analysis of risk factors and construction of predictive model for post-endoscopic retrograde cholangiopancreatography pancreatitis.Pak J Med Sci2023;39:1642-6 PMCID:PMC10626097

[26] Mohammad Alizadeh AH,Zafar Doagoo S.Preventive role of wire-guided cannulation to reduce hyperamylasemia and pancreatitis following endoscopic retrograde cholangiopancreatography.Diagn Ther Endosc2012;2012:821376 PMCID:PMC3403321

[27] Jamry A.Risk factors of pancreatitis after endoscopic sphincterotomy. Review of literature and practical remarks based on approximately 10,000 ERCPs.Pol Przegl Chir2017;89:29-33

[28] Sánchez-Ocaña R,Vila Costas J.SEED consensus document on SpyGlass-DS.Gastroenterol Hepatol2023;46:69-79

[29] Kayashima A,Iwasaki E.Non-interventional management of asymptomatic diminutive choledocholithiasis versus endoscopic extraction in consecutive patients.Dig Dis Sci2023;68:4456-65

[30] Facundo HG,Llanos DRC.Cholecystectomy 7 days vs 4 weeks after mild biliary pancreatitis; looking a decrease the incidence of persistent choledocholithiasis and ERCP: a multicentric randomized clinical trial.Int J Surg2022;98:106207

[31] Huang RJ,Girotra M.Practice patterns for cholecystectomy after endoscopic retrograde cholangiopancreatography for patients with choledocholithiasis.Gastroenterology2017;153:762-71.e2 PMCID:PMC5581725

[32] Lin Y,Cao DQ.Analysis of risk factors and prevention strategies of post-ERCP pancreatitis.Eur Rev Med Pharmacol Sci2017;21:5185-90

[33] Chandrasekhara V,Muthusamy VR.ASGE Standards of Practice CommitteeAdverse events associated with ERCP.Gastrointest Endosc2017;85:32-47

[34] Laugier R,Berthezene P.Changes in pancreatic exocrine secretion with age: pancreatic exocrine secretion does decrease in the elderly.Digestion1991;50:202-11

[35] Cankurtaran RE.Adverse events in endoscopic retrograde cholangiopancreticography for choledocholithiasis: a holistic perspective.Cureus2024;16:e53375 PMCID:PMC10908872

[36] Tintara S.Updates in post-endoscopic retrograde cholangiopancreatography pancreatitis.Gastroenterol Clin North Am2025;54:97-112

[37] Hayashi S,Shimakoshi H.Combination of two-hour post-endoscopic retrograde cholangiopancreatography amylase levels and cannulation times is useful for predicting post-endoscopic retrograde cholangiopancreatography pancreatitis.World J Gastrointest Endosc2016;8:777-84 PMCID:PMC5159676

[38] Liu WH,Hu X.Initial experience of visualized biliary cannulation during ERCP.Endoscopy2023;55:1037-42

[39] Fei L.Endoscopic management of bile leakage after laparoscopic operation of gallbladder and biliary tract.Lingnan Modern Clinical Surgery2015;15:276-9. (In Chinese)

[40] Berry R,Tabibian JH.Difficult biliary cannulation: historical perspective, practical updates, and guide for the endoscopist.World J Gastrointest Endosc2019;11:5-21 PMCID:PMC6354112

[41] Chen PH,Peng YC,Chang CS.Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study.BMC Gastroenterol2020;20:310 PMCID:PMC7520951

[42] Xu XD,Qian JQ.Prevention of pancreatitis after papillary balloon dilatation by nasobiliary drainage: a randomized controlled trial.Dig Dis Sci2015;60:1087-91

[43] Chan T,Rosing D.Total bilirubin is a useful predictor of persisting common bile duct stone in gallstone pancreatitis.Am Surg2008;74:977-80

[44] Sato D,Miyazaki K.Efficacy of endoscopic nasobiliary drainage for the prevention of pancreatitis after papillary balloon dilatation: a pilot study.Pancreas2005;31:93-7

[45] Xu XD,Qian JQ.Nasobiliary drainage after endoscopic papillary balloon dilatation may prevent postoperative pancreatitis.World J Gastroenterol2015;21:2443-9 PMCID:PMC4342922

[46] Freeman ML,Qi D.Pancreatic stent insertion: consequences of failure and results of a modified technique to maximize success.Gastrointest Endosc2004;59:8-14

[47] Freeman ML.Pancreatic stents for prevention of post-ERCP pancreatitis: the evidence is irrefutable.J Gastroenterol2014;49:369-70

[48] Kodydkova J,Stankova B,Krechler T.Antioxidant status and oxidative stress markers in pancreatic cancer and chronic pancreatitis.Pancreas2013;42:614-21

[49] Rosenbaum DM,Kessler JA.Superoxide dismutase ameliorates neuronal death from hypoxia in culture.Stroke1994;25:857-62

[50] Dabrowski A.Oxidative stress. An early phenomenon characteristic of acute experimental pancreatitis.Int J Pancreatol1992;12:193-9

[51] Pérez S,Sabater L.Redox signaling in acute pancreatitis.Redox Biol2015;5:1-14 PMCID:PMC4360040

[52] Wisløoff F,Osnes M.Stenosis of the common bile duct in chronic pancreatitis.Br J Surg1982;69:52-4

[53] Liu Y,Zhang B. Analysis of risk factors for acute pancreatitis in elderly patients after ERCP surgery. Available from https://d.wanfangdata.com.cn/thesis/ChhUaGVzaXNOZXdTMjAyNDA5MjAxNTE3MjUSCUQwMjM0MzQxMhoIdWNsNjgyMjU%3D [accessed 4 Auguest 2025].

[54] Jayaraj M,Dhindsa BS.Periampullary diverticula and ERCP outcomes: a systematic review and meta-analysis.Dig Dis Sci2019;64:1364-76

[55] Shi HX,Zhao HW.A new classification of periampullary diverticulum: cannulation of papilla on the inner margins of the diverticulum (Type IIa) is more challenging.BMC Gastroenterol2023;23:252 PMCID:PMC10369787

[56] Liu Y. Analysis of the causes and prognosis of severe acute pancreatitis complicated after ERCP procedure. Available from: https://kns.cnki.net/kcms2/article/abstract?v=oWJgMrFo8ueW-MCsl3UZNUUM2X_s-ZT3ITqPUaFMigyNnBhpuQ_eGusUZt84x3lgoUy3caIOkD6Q3o3eva7AD-UXhhr5DdPDOadMYlOvi1xJhz3qFSkr4rbkW0h1SnJ5LrxS0h5cUS-FnKXjhOFjJsH52N5acFVeb1uDfipUSLeMEUBS0IcCi-VRIx7x0cXv073Kswzo_eg=&uniplatform=NZKPT&language=CHS. [Last accessed on 4 Aug 2025].

[57] Tyagi P,Sharma BC.Periampullary diverticula and technical success of endoscopic retrograde cholangiopancreatography.Surg Endosc2009;23:1342-5

[58] Seetharam P.Sphincter of Oddi and its dysfunction.Saudi J Gastroenterol2008;14:1-6 PMCID:PMC2702883

[59] Ren LK,Ran X.Evaluating the efficacy of endoscopic sphincterotomy on biliary-type sphincter of Oddi dysfunction: a retrospective clinical trial.World J Clin Cases2021;9:9835-46 PMCID:PMC8610902

[60] Chen JW,Woods CM,Toouli J.Sphincter of Oddi dysfunction produces acute pancreatitis in the possum.Gut2000;47:539-45 PMCID:PMC1728061

[61] Liu Z,Gong J. Research progress on the relationship between sphincter of Oddi dysfunction and acute pancreatitis. Chongqing Medicine 2010;39:613-5. (in Chinese) Available from: https://kns.cnki.net/kcms2/article/abstract?v=oWJgMrFo8ue8bcNCwSDmi9SNVC_sdZBI1IllT-vPREKym8qMQ7nY3GvJgScLR534FxeFsGkhVeVLBOj-wIyg4zCWGvyUDXtiZPbjyojzuUeDmyPn4Ep2rMxy9sykEr4warIJR5RoR2MaJxy7OjV_kLXC8CQvONavFstuyd-tVRhEAuPMHa-60HAD9sfAfDNq&uniplatform=NZKPT&language=CHS. [Last accessed on 4 Aug 2025].

[62] Dong L, Liu X, Zhao W, Dang X, He J. Analysis of risk factors for pancreatitis after placement of pancreatic duct stent by endoscopic retrograde cholangiopancreatography. Med J Chin PLA. 2019;62:545-7. (in Chinese). Available from: https://kns.cnki.net/kcms2/article/abstract?v=oWJgMrFo8uf53u8niufS6F5Uw9dWjPz4mXdiD7g3yPtov9pwcAMjvvIhU-FSetqQpoCY_Rvts57mYGMcegjNTiWAvHQYJUPI4pPyrEFDKCmh0CMKWAr6q_pDPxtqG4BgCMBbwoPwelPfdC7VIKUB2bYmehpvgxEU2a_8IxlzcAxWCtzrJsWtW8k1xU6JfePJjQ-vbQJYnhE=&uniplatform=NZKPT&language=CHS. [Last accessed on 8 Aug 2025].

[63] Anwar SM,Shaukat R.Losartan-induced pancreatitis.Cureus2019;11:e6253 PMCID:PMC6937474

[64] García Gavilán MD, Moreno García AM, Rosales Zabal JM, Navarro Jarabo JM, Sánchez Cantos A. Case of drug-induced acute pancreatitis produced by horsetail infusions.Rev Esp Enferm Dig2017;109:301-4

[65] Fujisawa T,Hisatomi K,Nakajima A.Is endoscopic papillary balloon dilatation really a risk factor for post-ERCP pancreatitis?.World J Gastroenterol2016;22:5909-16 PMCID:PMC4948272

[66] Park JM,Chung MK.Antioxidative phytoceuticals to ameliorate pancreatitis in animal models: an answer from nature.World J Gastroenterol2014;20:16570-81 PMCID:PMC4248200

[67] Fujinami H,Ando T,Hosokawa A.Direct spraying of shakuyakukanzoto onto the duodenal papilla: a novel method for preventing pancreatitis following endoscopic retrograde cholangiopancreatography.Digestion2015;91:42-5

[68] Cui Y,Cai M,Zhao B.Gegen Qinlian decoction prevents post-ERCP pancreatitis by regulating NLRP3 inflammasome-mediated pyroptosis.Front Pharmacol2025;16:1588585 PMCID:PMC12226573

[69] Beran A,Ali AH.Predictors of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Comprehensive Systematic Review and Meta-analysis.Clin Gastroenterol Hepatol2024;Epub ahead of print

[70] Pereira Funari M,Mendonça Proença I.Pure cut or endocut for biliary sphincterotomy?.Am J Gastroenterol2023;118:1871-9

[71] Bytyçi I,Mikhailidis DP.Prevalence of statin intolerance: a meta-analysis.Eur Heart J2022;43:3213-23 PMCID:PMC9757867

[72] Bishay K,Khan R.Adverse events associated with endoscopic retrograde cholangiopancreatography: systematic review and meta-analysis.Gastroenterology2025;168:568-86

[73] Wang G,Zhu H.Development and external validation of a model for post-endoscopic retrograde cholangiopancreatography pancreatitis.iScience2025;28:112570 PMCID:PMC12146526

[74] Brenner T,Sperna Weiland CJ.Development and validation of a machine learning-based, point-of-care risk calculator for post-ERCP pancreatitis and prophylaxis selection.Gastrointest Endosc2025;101:129-38.e0

[75] Saito H,Kadono Y.Disease-based risk stratification of post-endoscopic retrograde cholangiopancreatography pancreatitis for common bile duct stones.Dig Dis Sci2022;67:305-14

[76] George AA,Kovoor JG.Artificial intelligence in capsule endoscopy: development status and future expectations.Mini-invasive Surg2024;8:4

[77] Yang Y. Analysis of risk factors associated with post-ERCP pancreatitis and hyperamylasemia. Available from: https://kns.cnki.net/kcms2/article/abstract?v=oWJgMrFo8ueG-Jp5VvQ0oMZCZdGwUyqUC8ZLlDLg76sIV8QUT9BwjqyhWR2k3mmo4xlkiVO9GIvzFQAjBTBlD_ir0QoODsB9rGKjRy1-FzyzFyRYTnrsZn52P2ZST19mD2xqXsK4Va6KLcfLoKgf_LfutQM4YHQKu9fyEowe9JGE7bLIpFd_Vof5zW4s9UOTbg0Gz_dp07Q=&uniplatform=NZKPT&language=CHS. [Last accessed on 4 Aug 2025].

[78] Liu Y. Analysis and prevention of related factors of post-ERCP pancreatitis. Available from: https://kns.cnki.net/kcms2/article/abstract?v=oWJgMrFo8ueG-Jp5VvQ0oMZCZdGwUyqUC8ZLlDLg76sIV8QUT9BwjqyhWR2k3mmo4xlkiVO9GIvzFQAjBTBlD_ir0QoODsB9rGKjRy1-FzyzFyRYTnrsZn52P2ZST19mD2xqXsK4Va6KLcfLoKgf_LfutQM4YHQKu9fyEowe9JGE7bLIpFd_Vof5zW4s9UOTbg0Gz_dp07Q=&uniplatform=NZKPT&language=CHS. [Last accessed on 4 Aug 2025].

[79] Wan X. Analysis of risk factors for post-ERCP pancreatitis and evaluation of prediction effects. Chin J Integr Med 2018;26:677-80. (in Chinese) Available from: https://kns.cnki.net/kcms2/article/abstract?v=oWJgMrFo8ucq6td3A4cPyVrgLGsXRN9bLcYxBQAkKW9_hOeDhWyrvsjLoZrnJGMiEIsbhIUzHPRZpYZxba4Ms0dY7kq0U-QYYZyluGDMYB28sXp97XYTAOhNTOIvTzXJvR0wF28pDKBOm22w0m0uncsW6GZzPYYHiYnN_ME9knVqEfPjQspdWc1dco-QewKyggwK0_Jdph0=&uniplatform=NZKPT&language=CHS. [Last accessed on 4 Aug 2025].

[80] Zhang Y. Analysis of risk factors for post-ERCP pancreatitis and its prevention. Available from: https://kns.cnki.net/kcms2/article/abstract?v=oWJgMrFo8ucbVo2J5599J4RXUI5HDIiRc_VE1q3pLt8A0qHnBJj2BMMLhj7o-KuNWjlEa7T0dK6w0FZvc3RECUQiq3rlz-cVco7UE_GsunVVdy8E-rk9bj9r-bOAtSpoKq5hOZDo6Zr8efAnUcqB0PiJE-iMTDM29_A9w3DjnOClxZvtOFGRi5Mx-RZLWeBYMXsKhKyF4Uo=&uniplatform=NZKPT&language=CHS. [Last accessed on 4 Aug 2025].

[81] Tong A.Analysis of risk factors for post-ERCP pancreatitis.

[82] Deng C. Analysis of surgical operation-related factors for post-ERCP pancreatitis. Available from: https://kns.cnki.net/kcms2/article/abstract?v=oWJgMrFo8ud4JEV6430Nhk9PtN8PW0iEqhb5JWppdgaGAKGi674RibYfqZMmyYlrRttCNqAxKiRPWNPgGW68o4R43OUbGryEZ0LYKcfrhptS2HVoK8afxeuNixJdQdvcJgD8OHPwzul36Dbp3em85MLAOo8V4c9xEqORsuED1IC9S363Pr7P5jkSahTzs67K8baqmJgQdyo=&uniplatform=NZKPT&language=CHS. [Last accessed on 4 Aug 2025].

[83] Zhang W. Analysis of risk factors for post-ERCP pancreatitis and hyperamylasemia and study on the effect of prophylactic administration of epinephrine. Available from: https://kns.cnki.net/kcms2/article/abstract?v=oWJgMrFo8ucnfwPKxeWM5bMFLq0LkRxdkvez1WjFIuSxHOCYz5KI_g8yBt5yy7QiefvG8ykkrzrIGdRTS4yWhpYGSxnO3ywIJkQRT0UTT8LzRt3BB8QUD3Dlr6f5K8xBKqaIwxSBYHTWu1cAzmQaNKWSCwy9KZLwXSdUOcGyCvJyt-VpgPHl4KPmlM0j-F_QqNR_FQDI2dc=&uniplatform=NZKPT&language=CHS. [Last accessed on 4 Aug 2025].

[84] Fang J. Analysis of risk factors for post-ERCP pancreatitis and establishment of prediction model. Master’s thesis, Zhejiang University, Hangzhou, Zhejiang, China. Available from: https://kns.cnki.net/kcms2/article/abstract?v=oWJgMrFo8ud2RFRmYF2eD1TlrqEjJcs99OaFmxgdg89bUKvGBOid1VJN4bwJ3u9zRo5l56TOCmgMYzYxGKLOTE-M_ieBhlA5Kq8RGKoIOs5iKXwOSqJghQuNj7b3T_6hpTDCQNG-y5lBaFnR4vpzEu1GoBvd2-gv7M8MI8LhKhLdnSp-AwofFjZQ-eiMNR5m-FDRxGiU2R4=&uniplatform=NZKPT&language=CHS. [Last accessed on 4 Aug 2025].

[85] Fan X,Li X. Analysis of relevant factors for pancreatitis or hyperamylasemia occurring after ERCP procedure. J Hebei Med Univ 2019;25:1166-9. (in Chinese) Available from: https://kns.cnki.net/kcms2/article/abstract?v=oWJgMrFo8ud8FpqeAUxh0uTU7YLwFzjek6M5ygUhOASMRY54e09dsRwEoOJ7I6vXCueG-DKLbmDosMQcQDKe010s_2zMwmUITnaW8U_K9b2mr8-P92-FHJ6wuSX3ytoglbDF0NTVfKwNOl_qgg87DO3xGBK7Y3It7_qgvU2YuJksB8rpgnqI0ss8aG3-PGylXBE42UIzpe4=&uniplatform=NZKPT&language=CHS. [Last accessed on 4 Aug 2025].

[86] Cheng H. Analysis of risk factors for pancreatitis complicated after ERCP procedure. Available from: https://kns.cnki.net/kcms2/article/abstract?v=oWJgMrFo8ufhyTyofDLq-t9cXlU5IUMR6XOnAYVblqeVcjaTnt6TiuR6WywLzeRMKPrp407qwVBtVSMbrWHRqRQgyOJuJu8WtoLk9PT_iY716xZ4Is3-KUryuyDblDSrhWC1mdwDO-LiemLpaqZkRKuba7PVY9XUuU1gkEBzhtufEG_OCPaqzNKB_5FDcg6NRXIjo1I1A8U=&uniplatform=NZKPT&language=CHS. [Last accessed on 4 Aug 2025].

[87] Perney P,Pageaux GP.Are drugs a risk factor of post-ERCP pancreatitis?.Gastrointest Endosc2003;58:696-700

[88] Chen T. Analysis of factors contributing to acute pancreatitis and development of predictive model in patients with early hyperamylasemia after ERCP. (In Chinese). Available from: https://link.cnki.net/doi/10.26925/d.cnki.gbbyc.2023.000358. [Last accessed on 8 Aug 2025].

[89] Funatsu E,Takenaka M.History of post-endoscopic retrograde cholangiopancreatography pancreatitis and acute pancreatitis as risk factors for post-ERCP pancreatitis.Kobe J Med Sci2017;63:E1-8. PMCID:PMC5824925

[90] Zhang M. Nomogram chart predicts the risk of post-ERCP pancreatitis occurrence after the first procedure. Available from: https://d.wanfangdata.com.cn/thesis/CiBUaGVzaXNOZXdTMjAyNTA2MTMyMDI1MDYxMzE2MTkxNhIJRDAyODAwNjQxGghkaG9wdWtyYg==. [Last accessed on 4 Aug 2025].

[91] Zhao ZH,Ren HB.Incidence and risk factors for post-ERCP pancreatitis in chronic pancreatitis.Gastrointest Endosc2017;86:519-24.e1

[92] Katsinelos P,Gkagkalis S.Predictive factors for post-ERCP pancreatitis: a large-scale single expertized endoscopist study.Surg Laparosc Endosc Percutan Tech2014;24:512-6

[93] Chen X,Wu X,Zhu Q. Logistic regression analysis of risk factors for post-ERCP pancreatitis after therapeutic ERCP. J Pract Med 2012;28:614-5. (in Chinese) Available from: https://kns.cnki.net/kcms2/article/abstract?v=oWJgMrFo8ucCzcPY6V6Q7rZ26qBezT8TZ_9nD1XKZzs9Yw19oy16P6bRA3BQ3I_Gm0avdUlIPPSGTLHlpN5xARr0mNjimvqN-prLFtt24m0DTM8B3NJ8m6kwPANf7096ThnLPWTwr8-Zb2jl4EAYxOv7F8iOsogVS0x0dKQqrmxF3vQKnfWFjqReT3uEs1HE&uniplatform=NZKPT&language=CHS. [Last accessed on 4 Aug 2025].

[94] Guo X.Analysis of the influencing factors of acute pancreatitis after endoscopic retrograde cholangiopancreatography.Med Res Home Abroad2022;20:128-31

[95] Liu Y,Chen D. Analysis of relevant factors and countermeasures for pancreatitis occurring after endoscopic retrograde cholangiopancreatography. Chin J Dig Endosc 2021;27:71-6. (in Chinese) Available from: https://kns.cnki.net/kcms2/article/abstract?v=oWJgMrFo8ufXeWqk0EiPqRGxShcbLirEFgUEI7MAqmhqZdT27rcBNPLBwAlxv1MkQW59Neo-_3XwNXlGni8rZHHcQlUZgL74L8FOTV1hhbu8JLlyV9kcgm9vSygS9OYt_JTc322GQmUeYzWKu1tIGhWXPPH-awIG_ZViUWLReilJ4tWw0ujgB7YqUfX6uP-Fg-iM6D5Vyss=&uniplatform=NZKPT&language=CHS. [Last accessed on 4 Aug 2025].

[96] Wang C. Analysis of risk factors for pancreatitis induced by endoscopic retrograde cholangiopancreatography. Clin Res 2019;27:5-7. (in Chinese) Available from: https://kns.cnki.net/kcms2/article/abstract?v=oWJgMrFo8ucEfCAlRqkrTTd-eIgybWnjCNFU7oUzZTMyPUR4SpTiQxAoqXXqfvJa-ItE4tiNpVbGoW7syJY3QzWFBzKmqDja2DGdrrqNbu052RVNmykrFNsth9QWGpRKv4_b37pVswdnvcKcq9BstsSovE-SAfC0HkJVNedAxaazzux5m1c_uCgpUq5yB4__SdU9px8OdDA=&uniplatform=NZKPT&language=CHS. [Last accessed on 4 Aug 2025].

[97] Yao J,Cao X,Zhu Q. Risk factors and construction of predictive model for post-endoscopic retrograde cholangiopancreatography pancreatitis. Nurs Res 2023;37:814-8. (in Chinese) Available from: https://kns.cnki.net/kcms2/article/abstract?v=oWJgMrFo8ufOPkq-ln8N2FyWRZKyGNQevPdqyIIdYpa72FxFZeKhqsE2u-rttpO2b2NQaojtC3-LLvAIz4yxZK17ZyM4ljvNPmZ1E0zP2RNAtinlYK_1w3EgAYbpSAN2eG2R0Q0Vlmut1Nkgg2DdeEn8b3zanVzx5xMPBg7FsfnF3IVyBo4DEtPFvySNRRNoiPlbm94eT2Q=&uniplatform=NZKPT&language=CHS. [Last accessed on 4 Aug 2025].

[98] Zhao Y.Analysis of risk factors and establishment of risk scoring system for complications after ERCP in patients with common bile duct stones. (In Chinese)

[99] Wang Y. Analysis of related factors for pancreatitis occurring after retrograde cholangiopancreatography for common bile duct stones. Smart Health 2021;7:93-5. Available from: https://link.cnki.net/doi/10.19335/j.cnki.2096-1219.2021.31.030. [Last accessed on 8 Aug 2025].

[100] Li Z.Analysis of the incidence and related risk factors of postoperative complications after ERCP in high-altitude areas.

[101] Song X. Risk factors for acute pancreatitis after ERCP. Henan Med Res 2020;29:2771-3. (in Chinese) Available from: https://kns.cnki.net/kcms2/article/abstract?v=oWJgMrFo8ufFKFhZpTLpeGLT6HTxXRQeghvM-Yo_iGw7lfr3duty258Z8cytpdHQae_h8zhXrwsjzMFj1mq79vLY-b0dR1nv9t9ahoH5QWiuOj1uBl3vbiNYGha-gtuw55njgdzlL4f6s2SMps4U_XRcyv1Wn7T34inqXVxQwmPUgDKqHfMQW7S-XIKHAvthF8Nx9l5oqkw=&uniplatform=NZKPT&language=CHS. [Last accessed on 4 Aug 2025].

[102] Xu B. Analysis of related factors of post-ERCP pancreatitis after therapeutic ERCP for obstructive jaundice. Available from: https://kns.cnki.net/kcms2/article/abstract?v=oWJgMrFo8ucEz3WgnELOSEY-LspVuz1TclqRAO2cBcKxRpNn3Bg2Sn7bLvZ9agC060AJvyXW6PH3CKUpetDtMF4xjYsgf70alBSp6f79A32SoOKnUHhiJwrwbPEO6YewLWU_riy-DK3fe8NwKH6VkNHFXejEl1jGAP5y4r89gcYldge0XLxCn06lAFIyj1Xexw83FAiPrNs=&uniplatform=NZKPT&language=CHS. [Last accessed on 4 Aug 2025].

[103] Yang S. The influence of intubation time on postoperative pancreatitis after endoscopic retrograde cholangiopancreatography. Available from: https://d.wanfangdata.com.cn/thesis/CiBUaGVzaXNOZXdTMjAyNTA2MTMyMDI1MDYxMzE2MTkxNhIJRDAxMjc0MDA0Ggh6dGV2OWNiZQ%3D%3D. [Last accessed on 4 Aug 2025].

[104] Li Y,Liu A. The relationship between uneven dilation of the bile duct and post-ERCP pancreatitis. J Kunming Med Univ 2023;44:131-7. (in Chinese) Available from: https://kns.cnki.net/kcms2/article/abstract?v=oWJgMrFo8uegmACI_plE1AdnGC7YDQXtQC0bOfeZOaVhmYNp7YDPWPLBiW9YH71o2Ub3_Vb66Dw49Y7tN1PJ3dv_5TvSylAJtNQeRKqoYLYWh9G_Rl4srtx0gf9QpZg7dK9yUYOEA1JmXyJ5Sc_FRMU_vzAmNcCj0AXPZcR-Ak8JT_jyz3hdnFvB8jfqV_h6swVlgqhhJNY=&uniplatform=NZKPT&language=CHS. [Last accessed on 4 Aug 2025].

[105] Zhang X, Tan N, Zhou Y, Yu Y, Ji G. Analysis of related factors for pancreatitis occurring postoperatively after retrograde cholangiopancreatography for common bile duct and main trunk stones. Contemp Chin Med. 2017;24:30-2. (In Chinese). Available from: https://kns.cnki.net/kcms2/article/abstract?v=FqAfUZ3F7badEGLN5tjbmH73C5-S7vo2Cf3qg9GaEks8wiYUM8PKqVOdNWQPbhGKoLmozUXeTGSkE0Sl9P16Ip1iwrioLc9jKUzkclVD4m4vFkygkjs3rbGWRbKHT9KSGXi0_VdFtrC0rpKdz4v1J-hTiIyKRSOjNVVG_xoThkgZm8BeSvNIdg==&uniplatform=NZKPT&language=CHS. [Last accessed on 8 Aug 2025].

[106] Zhang X, Zhang J, Pei Z, et al. Study on the impact of gallbladder condition on post-ERCP pancreatitis and the development of prediction model. J Lanzhou Univ. 2022;48:44-9. (In Chinese) Available from: https://link.cnki.net/doi/10.13885/j.issn.1000-2812.2022.01.010. [Last accessed on 8 Aug 2025].

[107] Zhu J, Huang Z, Wang G. Analysis of factors influencing the efficacy of endoscopic retrograde cholangiopancreatography in difficult cases and postoperative Ac pancreatitis with different assisting catheterizations. J Hebei Med Univ. 2022;28:1135-41. (In Chinese). Available from: https://kns.cnki.net/kcms2/article/abstract?v=FqAfUZ3F7bahRKyS80qC-CmU1aXgJAJy_SRssIfvyQvb2az0jCUtCgS1sMdMT3772syAWH0bj4iQLasmlznwCwsnlwyF34JP08YQYYUXm6HD0VwMoZOBOfKQbaeVID52hKy8D2b0-Uyn2lqt7COWrWYcVhK5YpTr7y6h8xM5Y4FrYFfhoL_SbA==&uniplatform=NZKPT&language=CHS. [Last accessed on 8 Aug 2025].

[108] Yang Y.The influence of intubation time on postoperative pancreatitis in patients undergoing difficult ERCP intubation procedures. (In Chinese).

[109] Ma M, Zhou Z. Comparative observation on acute pancreatitis and hyperamylasemia after endoscopic retrograde cholangiopancreatography. J Clin Hepatobiliary Dis. 2020;36:395-8. (In Chinese). Available from: https://kns.cnki.net/kcms2/article/abstract?v=FqAfUZ3F7ba7I7gmPMYnnT_r0RSrJMkxO8ApoFViP6TnvGlimcQbsMiICM1i9lYyMZYmM6s10e9Oo84w4zwnB_HjeyvOmm4-bZXwe3syT9SfNbtTZTWfJu7Llv5Tn-aq_t6MlXmrLJuoStzQ2OmY3t9ybUT4ayHHwPJ_GB640qr4ZwFaGbqEGw==&uniplatform=NZKPT&language=CHS. [Last accessed on 8 Aug 2025].

[110] Wang M,Wu C,Shi H.Study on changes of inflammatory factors and immune function in elderly patients with common bile duct stones before and after ERCP treatment and risk factors for postoperative pancreatitis complications.Adv Mod Biomed2022;22:2265-93

[111] Wang X. Analysis of risk factors related to post-ERCP pancreatitis. Available from: https://d.wanfangdata.com.cn/thesis/CiBUaGVzaXNOZXdTMjAyNTA2MTMyMDI1MDYxMzE2MTkxNhIJRDAyNTk2MzYxGghxbWQ5bWZmNw%3D%3D. [Last accessed on 4 Aug 2025].