Indomethacin prevents post-ERCP pancreatitis: the addition of topical epinephrine to indomethacin does not improve benefit

Nikhil Ravi Thiruvengadam, Michael L. Kochman


We read with interest this recent randomized control trial from Kamal et al. in the American Journal of Gastroenterology (1). They compared topical epinephrine spray applied to the papilla along with rectal indomethacin to rectal indomethacin alone in high-risk patients and found no significant difference in rates of post-endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis (PEP) (6.7% vs. 6.4%). There were no differences in rates of moderate to severe PEP.