Comparative study of prophylactic rectal indomethacin and/or papillary spray of adrenaline in prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with sphincterotomy

Background and aim Endoscopic retrograde cholangiopancreatography is a frequently used technique for diagnostic and therapeutic biliary problems. Post‐ERCP pancreatitis (PEP) is a common complication that may be severe enough to be life-threatening. This study aimed to compare rectal indomethacin versus papillary spray of adrenaline, and rectal indomethacin with papillary spray adrenaline in the prevention of PEP. Patients and methods A total of 200 patients were randomly divided into a control group; including 50 patients who did not receive any prophylaxis against PEP, an indomethacin group; included 50 patients who received rectal indomethacin suppository, an epinephrin spray group; included 50 patients in whom epinephrin spray was used and combined group; included 50 patients who received rectal indomethacin suppository and, epinephrin spray was used. Results A total of 15 (7.5%) patients developed PEP while the other 185 (92.5%) patients did not develop PEP. A significant difference between studied groups as regards PEP ( P =0.04). The control group had the highest frequency of PEP (16%) followed by the epinephrin spray group (8%) and rectal indomethacin group (4%). There was only one patient in the combination group who developed PEP. Conclusion Prophylactic use of a combination of rectal indomethacin with a papillary spray of adrenaline could be effective in the prevention of PEP. In general, the use of rectal indomethacin alone or in combination with a papillary spray of adrenaline would be effective in prevention of PEP.