AI-Based Prediction of Post-ERCP Pancreatitis: A Comparative Study Using Tabular, Image, and Multimodal Data

Background/Objectives: Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis (PEP) is a clinically significant complication of ERCP, occurring in approximately 2-10% of general cases and at higher rates in high-risk patients. Early prediction of PEP risk may support timely intervention and improved patient management. This retrospective single-center study comparatively evaluated tabular clinical data, endoscopic image data, and multimodal fusion approaches for PEP prediction. Methods: Retrospective data collected from the Sindh Institute of Advanced Endoscopy and Gastroenterology were analyzed using machine learning and deep learning techniques. XGBoost(version 3.2.0) was applied to tabular clinical data, while EfficientNet-B0, ResNet50, and DenseNet201 were used for endoscopic image analysis. A multimodal contrastive learning (MMCL)-based framework combining ResNet50 image features with multilayer perceptron (MLP)-based tabular features was additionally implemented for binary PEP prediction. Class imbalance mitigation techniques, including data augmentation and balancing strategies, were applied during training. Model performance was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, F1-score, and precision. SHAP analysis was performed to identify important predictive features. Results: The tabular XGBoost model achieved the best predictive performance with an AUC of 0.95 and a sensitivity of 0.50, while five-fold cross-validation yielded an AUC of 0.79 and a sensitivity of 0.48. Among image-based models, ResNet50 achieved the highest performance, with an AUC of 0.76 and a sensitivity of 0.40. The multimodal model achieved an AUC of 0.57 and a sensitivity of 0.20. SHAP analysis identified cannulation time, ampulla type, and age as prominent features associated with PEP prediction. Conclusions: This exploratory study suggests that structured clinical data currently provide stronger predictive signals for PEP prediction than the available image and multimodal data within this limited cohort. The relatively low occurrence of PEP contributed to class imbalance despite mitigation strategies. Future multicenter studies with larger datasets, improved image availability, synthetic data generation, and advanced multimodal fusion techniques may improve predictive performance and clinical applicability.