ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Gastrointestinal and Hepatic Pharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1675615
This article is part of the Research TopicReviews in Gastrointestinal and Hepatic Pharmacology: 2024View all 15 articles
Efficacy of Indomethacin for the Prevention of Post-ERCP Pancreatitis: A Comprehensive Meta-Analysis of Randomized Controlled Trials
Provisionally accepted
- Hangzhou First People's Hospital, Hangzhou, China
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Background: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a common and potentially serious adverse event. This meta-analysis aimed to comprehensively assess the efficacy of indomethacin therapy in reducing PEP risk. Methods: We searched PubMed, Embase, Scopus, and Cochrane Library databases to identify RCTs that compared rectal indomethacin with a control group to prevent PEP. A random-effects model was applied to produce pooled risk ratios (RRs) with 95% confidence intervals (CIs). Results: We included a total of 30 RCTs involving 16,977 patients. Compared to the control group, rectal indomethacin showed comparable rates of overall post-ERCP pancreatitis (PEP; RR 0.85, 95% CI 0.69-1.04), with no statistically significant difference of RR in mild (0.92), moderate (0.78), or severe PEP (1.12). There was also no difference in RR of the cases of adverse events (0.97), abdominal pain (1.14), bleeding (1.07), or mortality (0.86) between the two groups. Subgroup analyses were also performed. Conclusion: Rectal indomethacin appears to be safe and may offer benefit in selected high-risk patients, though findings should be interpreted with caution due to high heterogeneity.
Keywords: Post-ERCP pancreatitis, Indomethacin, Pancreatitis prevention, prophylaxis, Meta-analysis
Received: 29 Jul 2025; Accepted: 13 Aug 2025.
Copyright: © 2025 Tian, Huang, Khizar and Qiu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Kai Qiu, Hangzhou First People's Hospital, Hangzhou, China
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