cholangiopancreatography (ERCP) is a non-invasive procedure used commonly for
the diagnosis and treatment of bile and pancreatic duct problems. In an ERCP
procedure, an endoscope is inserted through the patient's mouth and radiographic
images of the duct draining the gallbladder, liver and pancreas are taken.
Later theses images are studied to find out the actual condition of the duct.
Pancreatitis is the
inflammation of the pancreas. The chief complaints in post-ERCP pancreatitis are
upper abdominal pain and raised level of pancreatic enzymes. Post-ERCP
pancreatitis is a complication resulting in one quarter of patients undergoing
ERCP. Although the condition has been researched for years, this study is the
first breakthrough revealing how post-ERCP pancreatitis can be effectively
placebo-controlled trial was conducted where 602 patients were given rectal
indomethacin or placebo soon after ERCP. They were given two Indomethacin 50-mg
rectal suppository and matching placebo immediately after the ERCP.
M.D. gastroenterologist and the lead author of the study stated, "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."
The pancreas suddenly
becomes swollen in post-ERCP pancreatitis. According to the experts, this
complication results in approximately $150 million being spent on health care
services per annum.
It was found that the
patients who received indomcethacin-the anti-inflammatory drug rectally soon
after the ERCP procedure had less chances to be hospitalized with pancreatitis.
Incidentally, the cost of a single dose of indomethacin is $5.
The study highlighted
that only 9.2 percent of the patients receiving indometahcin post-ERCP reported
pancreatitis. They had 46 percent less chances in contrast to those who were
About 16.9 percent of
placebo administered patients developed pancreatitis.
According to the
experts indomethacin being an NSAID (non-steroidal anti-inflammatory drug), it
suppresses the inflammatory responses of the pancreas occurring post ERCP
Evan L.Fogel, the
gastroenterologist and co-author of the study mentioned, "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", they said.
Joseph Elmunzer et al
said that their study findings provided simple treatment for preventing
post-ERCP pancreatitis. Elmunzer finally concluded that the results obtained
with rectal administration of indomethacin were protective against post-ERCP
The experts are of the
opinion that the results of the trial have already affected the clinical
A Randomized Trial of Rectal Indomethacin to
Prevent Post-ERCP Pancreatitis; Joseph Elmunzer et al; N Engl J Med 2012;