Post-ERCP Pancreatitis — Time for Universal Use of Preprocedure Rectal Indomethacin

In patients at high risk for post–endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), use of pancreatic stents or postprocedure intrarectal indomethacin decreases PEP risk dramatically. Post-ERCP indomethacin has largely supplanted stents in many practices because of its efficacy, ease of use, and low cost. However, the optimal timing (pre- vs. postprocedure) of intrarectal indomethacin administration is still unclear, as is its potential benefit in average-risk patients.

In a multicenter trial in China, investigators randomized 2600 patients undergoing ERCP to a group receiving universal preprocedure intrarectal indomethacin or a group receiving risk-stratified postprocedure intrarectal indomethacin (i.e., administered…