In this study, rectal indomethacin was found to substantially minimize the risk of post-ERCP pancreatitis (PEP) by down-regulating the levels of high mobility group box 1 (HMGB1) and tumor necrosis factor-alpha (TNF-α).

The study was conducted to assess the efficacy and mechanism of NSAIDs for PEP prophylaxis in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP).

The study enrolled 100 patients who underwent ERCP. Participants were randomly allocated to either 100 mg rectal indomethacin group (n=50) or glycerin suppository 15-20 min before the ERCP group (n=50). The rate of PEP was the primary outcome parameter.  Before ERCP and three and 24 h after ERCP, the levels of serum HMGB1 and TNF-α were also ascertained. To assess the independent risk factors for PEP, the univariate and multivariate analysis were conducted.

Compared to the control group, the no. of patients in which PEP developed was less in the indomethacin group, as depicted in the following table:

Compared to the control group, the levels of HMGB1 and TNF-α declined considerably in the indomethacin group at 3 and 24 h after ERCP. According to the multivariate analysis, the independent predictors of PEP were the duration of ERCP and the usage of NSAIDs.

In patients undergoing ERCP, rectal indomethacin can lower the risk of PEP by down-regulating the levels of HMGB1 and TNF-α.