The incidence of pancreatitis after ERCP was considerably reduced if patients were administered rectal indomethacin after their procedure, researchers from the University of Michigan Health System and Indiana University Medical Center reported in NEJM (New England Journal of Medicine. ERCP (endoscopic retrograde cholangiopancreatography) is a procedure that is commonly utilized to treat or diagnose problems of the bile and pancreatic ducts.

The authors explained that their findings may lead to a simple treatment that could prevent a condition called post-ERCP pancreatitis, a complication that can affect up to one quarter of all patients who undergo ERCP.

Even though this complication has been studied for years, this clinical trial is the first to compellingly show how effectively post-ERCP pancreatitis can be avoided.

An interim analysis that clearly demonstrated the safety and benefit for the initial 600 patients who had enrolled ended early. The authors say the results of the trial have already altered clinical practice in this field.

Lead study author and gastroenterologist, B. Joseph Elmunzer, M.D., said:

“ERCP is a very important procedure that can provide life-saving interventions for people who need it, although it is considered the most invasive of all the endoscopic procedures and it does have risks associated with it.”

In post-ERCP pancreatitis, the pancreas suddenly swells. Experts say this complication incurs approximately $150 million annually in health care costs.

The study found that patients who were given anti-inflammatory indomethacin rectally after their ERCP procedure were dramatically less likely to have to be hospitalized with pancreatitis. One dose of indomethacin costs under $5.

The researchers believe indomethacin, an NSAID (non-steroid anti-inflammatory drug), inhibits an inflammatory response by the pancreas; a complication risk after ERCP.

During an ERCP procedure, a lighted scope is inserted through the mouth while X-ray pictures are taken to check the tubes that drain the liver, pancreas and gallbladder.

Co-author and gastroenterologist Evan L. Fogel, M.D., said:

“Our findings showed that one dose of indomethacin given immediately after ERCP significantly reduced the incidence of post-ERCP pancreatitis in patients at elevated risk for this complication.

We found that prophylactic indomethacin decreased the severity of post-ERCP pancreatitis and was associated with shorter hospital stays.”

The authors reported that in their study:

  • 9.2% of those who were given indomethacin post-ERCP developed pancreatitis (46% lower chance compared to those on placebo)

  • 16.9% of those who took a placebo developed pancreatitis

Elmunzer says:

“The results of the study were very impressive. We found that indomethacin was
highly protective.

The risk of post-ERCP pancreatitis is in the range of 5 percent, however there are patients who are at higher risk, and without any form of prevention can have up to a 25 percent chance of developing this complication.”

Written by Christian Nordqvist