Impact of indomethacin combined with pancreatic duct stent placement on high-risk populations of pancreatitis after endoscopic retrograde cholangiopancreatography

Abstract

BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) is widely used technique for the diagnosis and treatment of pancreaticobiliary diseases. However, post-ERCP pancreatitis (PEP) has become the main issue restricting the extensive application of this technique, and there is an urgent need for more precise and targeted preventive strategies in clinical practice.

AIM

To explore the effect of indomethacin plus pancreatic duct stent implantation on high-risk populations for PEP.

METHODS

This prospective study included 386 patients who underwent ERCP in Peking University Shougang Hospital between April 2023 and March 2025 and were at high risk of pancreatitis. They were randomly divided into the indomethacin (rectally administered with indomethacin suppositories, n = 129), stent (implanted with pancreatic duct stents, n = 128), and combined (indomethacin plus pancreatic duct stent implantation, n = 129) groups. Inflammatory factors, preoperative and postoperative immune function, incidence of postoperative pancreatitis and severe pancreatitis, symptom remission time, and hospital stay were compared.

RESULTS

Preoperatively, no significant differences were found in the levels of inflammatory factors and immune function among the three groups (P > 0.05). Postoperatively, the levels of inflammatory factors, including interleukin-6, interleukin-10, and C-reactive protein, were lower in the combined group than in the indomethacin and stent groups. Meanwhile, CD4+ and CD4+/CD8+ levels were significantly higher in the combined group than in the indomethacin and stent groups, whereas the CD8⁺ level was significantly lower (P < 0.05). However, no significant differences were noted in the incidence of PEP and severe PEP among the three groups (P > 0.05). The pain remission time and hospital stay duration were significantly shorter in the combined group than in the indomethacin and stent groups (P < 0.05).

CONCLUSION

Indomethacin plus pancreatic duct stent implantation can mitigate the inflammatory response in high-risk populations for PEP, enhance immune function, and shorten the postoperative pain remission time and hospital stay.

Keywords: Post-operative pancreatitis; Endoscopic retrograde cholangiopancreatography; Pancreatic duct stent; Indomethacin

Core Tip: This study demonstrates that combining indomethacin suppositories with pancreatic duct stent placement significantly reduces postoperative inflammatory markers (interleukin-6, interleukin-10, C-reactive protein) and improves immune function (higher CD4+/CD8+ ratio) in high-risk post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) patients. The dual intervention also shortens pain relief time and hospital stays compared to monotherapy, offering a synergistic strategy to mitigate PEP-related complications. Key findings highlight its superiority in modulating inflammation and enhancing recovery without increasing severe PEP incidence.