Pharmacologic prevention of pancreatitis after endoscopic retrograde cholangiopancreatography: Present and future

Despite extensive research over the past 2 decades, effective prevention of post–endoscopic retrograde cholangiopancreatography pancreatitis (PEP) using pharmacologic agents has been elusive. Recently, research that is focused on nonsteroidal anti-inflammatory drugs has provided renewed hope by demonstrating that a medication can indeed prevent PEP. Today, based on high-quality clinical trial data, rectal nonsteroidal anti-inflammatory drugs can be recommended for preventing PEP in high-risk cases,and given the highly favorable risk and cost-benefit ratios, they should be considered for all patients undergoing endoscopic retrograde cholangiopancreatography. Ongoing research will define the optimal dose of rectal indomethacin and whether this medication can eliminate the need for prophylactic pancreatic stent placement in high-risk cases. Additional research is necessary to define the role of other promising pharmacologic agents in clinical practice.