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World J Gastroenterol. Aug 21, 2012; 18(31): 4082-4085
Published online Aug 21, 2012. doi: 10.3748/wjg.v18.i31.4082
Indomethacin for post-endoscopic retrograde cholangiopancreatography pancreatitis prophylaxis: Is it the magic bullet?
Dennis Yang, Peter V Draganov
Dennis Yang, Peter V Draganov, Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Florida, Gainesville, FL 32610, United States
Author contributions: Yang D performed the literature search and wrote the first draft of the manuscript; Draganov PV provided the concept for the manuscript, contributed new articles to the literature search, reviewed the article and provided critical appraisal.
Correspondence to: Peter V Draganov, MD, Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Florida, 1600 SW Archer Road, Room HD 602, PO Box 100214, Gainesville, FL 32610, United States.
Telephone: +1-352-2739474 Fax: +1-352-3923618
Received: June 20, 2012
Revised: July 10, 2012
Accepted: July 18, 2012
Published online: August 21, 2012

Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography (ERCP). Pancreatic duct stent insertion after ERCP has been widely accepted as the standard of care for the prevention of this complication in high-risk patients. Unfortunately, the placement of pancreatic stents requires higher level of endoscopic expertise and is not always feasible due to anatomic considerations. Therefore, effective non-invasive pharmacologic prophylaxis remains appealing, particularly if it is inexpensive, easily administered, has a low risk side effect profile and is widely available. There have been multiple studies evaluating potential pharmacologic candidates for post-ERCP pancreatitis (PEP) prophylaxis, most of them yielding disappointing results. A recently published large, multi-center, randomized controlled trial reported that in high risk patients a single dose of rectal indomethacin administered immediately after the ERCP significantly decreased the incidence of PEP compare to placebo.

Keywords: Non-steroidal anti-inflammatory drugs, Indomethacin, Post-endoscopic retrograde cholangiopancreatography pancreatitis, Acute pancreatitis