Role of rectal NSAID administration time in prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis

Objectives Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Many NSAIDs have been used to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). We aimed to evaluate the appropriate time to start rectal indomethacin in patients undergoing ERCP for treatment of calcular obstructive jaundice for prevention of PEP. Patients and methods Over 10 months, 80 consecutive patients with calcular obstructive jaundice underwent ERCP. Patients were assigned to receive indomethacin suppository 100 mg either just before the procedure (group A=30 patients), directly after the end of the procedure (group B=30 patients), or just before and 5 h after the procedure (group C=20 patients). Serum amylase levels and clinically pertinent evaluations were measured in all patients after ERCP. Results Of 80, 18 (22.5%) patients developed PEP. The rate of PEP was lower in group C patients (15.0%) when compared with groups A and B (30.0 and 20.0%, respectively). No patients in group C had severe PEP in comparison with 11% in group A and 17% in group B. Conclusion This study shows that rectal indomethacin given immediately before and 5 h after ERCP can reduce the incidence and severity of PEP.