Tian F, Huang ZC, Khizar H, Qiu K. Efficacy of indomethacin for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: A comprehensive meta-analysis of randomized controlled trials. World J Gastroenterol 2026; 32(1): 113232 [DOI: 10.3748/wjg.v32.i1.113232]
Corresponding Author of This Article
Kai Qiu, MD, Department of Intensive Care Unit, Hangzhou Geriatric Hospital, No. 50 Jingshen Road, Hangzhou 310022, Zhejiang Province, China. 1007743527@qq.com
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Gastroenterology & Hepatology
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Meta-Analysis
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Jan 7, 2026 (publication date) through Jan 12, 2026
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World Journal of Gastroenterology
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1007-9327
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Tian F, Huang ZC, Khizar H, Qiu K. Efficacy of indomethacin for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: A comprehensive meta-analysis of randomized controlled trials. World J Gastroenterol 2026; 32(1): 113232 [DOI: 10.3748/wjg.v32.i1.113232]
World J Gastroenterol. Jan 7, 2026; 32(1): 113232 Published online Jan 7, 2026. doi: 10.3748/wjg.v32.i1.113232
Efficacy of indomethacin for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: A comprehensive meta-analysis of randomized controlled trials
Fu Tian, Zhi-Cheng Huang, Hayat Khizar, Kai Qiu
Fu Tian, Zhi-Cheng Huang, Kai Qiu, Department of Intensive Care Unit, Hangzhou Geriatric Hospital, Hangzhou 310022, Zhejiang Province, China
Hayat Khizar, Department of Surgery, The Fourth Affiliated Hospital of School of Medicine, International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 320000, Zhejiang Province, China
Author contributions: Tian F and Huang ZC contributed to writing the original paper, retrieved the articles, and did data extraction and data analysis; Khizar H was responsible for image editing, correction, and data analysis; Qiu K was responsible for provided article ideas and article review.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kai Qiu, MD, Department of Intensive Care Unit, Hangzhou Geriatric Hospital, No. 50 Jingshen Road, Hangzhou 310022, Zhejiang Province, China. 1007743527@qq.com
Received: August 19, 2025 Revised: September 3, 2025 Accepted: September 30, 2025 Published online: January 7, 2026 Processing time: 139 Days and 0.7 Hours
Abstract
BACKGROUND
Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a prevalent and potentially serious complication in patients undergoing endoscopic retrograde cholangiopancreatography.
AIM
To comprehensively assess the efficacy of indomethacin therapy in reducing PEP risk.
METHODS
We searched PubMed, EMBASE, Scopus, and Cochrane Library databases to identify randomized controlled trials (RCTs) that compared rectal indomethacin with a control group to prevent PEP. Duplicates were removed, and studies were included based on the established inclusion criteria. We used the Cochrane Collaboration’s tool to assess the risk of bias in the RCTs. 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 16977 patients. Compared to the control group, rectal indomethacin showed comparable rates of overall PEP (PEP; RR = 0.85, 95%CI: 0.69-1.04, I2 = 79%) with no statistically significant difference of RR in mild (RR = 0.92, 95%CI: 0.74-1.14), moderate (RR = 0.78, 95%CI: 0.59-1.02), or severe PEP (RR = 1.12, 95%CI: 0.75-1.67). There was also no difference in cases of adverse events (RR = 0.97, 95%CI: 0.69-1.35), abdominal pain (RR = 1.14, 95%CI: 0.80-1.62), bleeding (RR = 1.07, 95%CI: 0.70-1.63), or mortality (RR = 0.86, 95%CI: 0.56-1.33) 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.
Core Tip: This meta-analysis assessed the efficacy of rectal indomethacin in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis by reviewing the results of 30 randomized controlled trials. Indomethacin didn’t show a significant reduction in overall post-endoscopic retrograde cholangiopancreatography pancreatitis rates or adverse events relative to controls, however, it may be beneficial in particular high-risk patients, but with caution given to significant heterogeneity in the results.
