Prophylactic Indomethacin for Post-ERCP Pancreatitis

In a largely low-risk cohort, rectal indomethacin was associated with less-severe pancreatitis after ERCP.

Phospholipase A₂ plays a critical role in the initial inflammatory cascade of acute pancreatitis. Nonsteroidal anti-inflammatory drugs (NSAIDs) are potent inhibitors of phospholipase A₂, with indomethacin being among the most effective. To determine whether prophylactic indomethacin could prevent pancreatitis after endoscopic retrograde cholangiopancreatography, researchers in Iran randomized 490 patients to receive rectal indomethacin (100 mg) or placebo prior to ERCP.

The overall pancreatitis rate was 5%; pancreatitis occurred in 3% of the indomethacin group and in 7% of the placebo group (P=0.06). The incidence of moderate-to-severe pancreatitis was significantly higher in the placebo group (P=0.03). In the subgroup of patients (87) who r…

Reviewing Author

Stuart Sherman, MD