S10 A Retrospective Single Center Case Series of Prophylactic Rectal Indomethacin Use During Endoscopic Ultrasound Guided Pancreatic Biopsy: A Pilot Study

Introduction: Endoscopic retrograde cholangiopancreatography is a known cause of post-procedure pancreatitis, for which prophylactic indomethacin is commonly used. Similarly, pancreatitis can occur after Endoscopic Ultrasound (EUS) with fine-needle aspiration (FNA) or fine-needle biopsy (FNB) of the pancreas. However, there is limited data evaluating the use of indomethacin to prevent pancreatitis after a biopsy. This is a retrospective study looking at the role of indomethacin in pancreatic biopsy. Methods: We conducted a single-center retrospective study evaluating patients who underwent EUS-guided FNA or FNB of the pancreas. Indomethacin administration was at the discretion of the endoscopist. Data collected included procedural indications, lesion characteristics, needle type, number of passes, communication with the pancreatic duct, and post-procedural complications. Patients were monitored for symptoms and instructed to report any post-procedural pain. A total of 80 patients were included: 40 received rectal indomethacin and the other 40 patients did not. Results: A total of 80 patients were included. The various indications included mass, cyst, stricture, and parenchymal abnormalities. Both cysts and masses were either aspirated and/or biopsied. Figure 1 includes the patient who did not have pancreatitis after the post-procedure. Figure 2 breaks down the characteristics of the patients who had pancreatitis post- procedurally [Figures presented at ACG annual meeting]. Four cases of post procedural pancreatitis were noted: 3 in patients who did not receive indomethacin and 1 patient who received indomethacin. The odds ratio was 4.33 (95% CI: 0.46–40.61; P = 0.359). Conclusion: This pilot study suggests that indomethacin may reduce the incidence of post-EUS pancreatitis, though the difference was not statistically significant. Communication with the pancreatic duct may be a contributing risk factor. No major complications were observed in either group. Four patients developed pancreatitis. The 3 cases that did not receive indomethacin had a mass or a cyst that was in communication with the pancreatic duct and were hospitalized for pancreatitis. In the patient who received indomethacin, it is unclear whether there was communication with the pancreatic duct and symptoms improved in 24 hours. Limitations include small sample size and variability in documentation. A larger, prospective randomized trial is currently underway to further investigate the role of indomethacin in patients undergoing pancreatic FNA/FNB.