ReviewWorld journal of gastrointestinal surgery2025
Post-endoscopic retrograde cholangiopancreatography pancreatitis: Mechanistic pathways, diagnostic benchmarks, and emerging and mitochondria-targeted therapies.
Review in World journal of gastrointestinal surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed.
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
This study presents a comprehensive overview of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), detailing its epidemiology, pathophysiology, prevention, and treatment. PEP is the most common complication of ERCP, with an incidence of 3%, 16%, and above 20% in high-risk patients. Proposed mechanisms include mechanical trauma, pancreatic-duct (PD) hypertension, oxidative stress, and dysbiosis-driven inflammation. Mitochondrial oxidative stress is a central pathological driver: It activates the NLRP3 inflammasome and the STING pathway, perpetuating a deleterious "injury-inflammation" cycle. Risk factors encompass patient characteristics, procedural variables, and operator-related factors. Preventive strategies combine pharmacological and procedural measures. Rectal non-steroidal anti-inflammatory drugs (NSAIDs), such as indomethacin, inhibit prostaglandin synthesis. European guidelines report that NSAIDs reduce the overall incidence of PEP, with odds ratios of 0.24-0.63. Subgroup analyses indicate the greatest benefit in high-risk cohorts, with mixed-risk groups also deriving more benefit than average-risk groups. In high-risk patients, prophylactic PD stenting markedly lowers PEP incidence by alleviating ductal hypertension. Aggressive fluid resuscitation enhances pancreatic perfusion and decreases the frequency of moderate-to-severe PEP. Recent therapeutic advances emphasize targeted interventions. Mitochondria-directed nanomedicines cross the blood-pancreas barrier, scavenge reactive oxygen species, and attenuate inflammatory cascades. A multidisciplinary team (MDT) approach optimizes infection control and manages complications in severe PEP, improving clinical outcomes. Future research should focus on addressing genetic susceptibility, developing novel targeted agents, and integrating artificial intelligence-assisted risk stratification to refine personalized prevention and therapy. This article reviews the epidemiological and pathophysiological foundations of PEP, evaluates evidence-based preventive strategies (
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