SynthesisDigestive diseases and sciences2026
Rectal Diclofenac Versus Indomethacin in Preventing Post-ERCP Pancreatitis: A Systematic Review and Meta-Analysis.
Synthesis in Digestive diseases and sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
11 authors.
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Abstract
introductionPost-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) affects up to 9% of average-risk and 40% of high-risk patients. Rectal NSAIDs are guideline-recommended for PEP prophylaxis, yet direct evidence comparing different NSAIDs remains scarce. This study systematically evaluates head-to-head evidence to compare the efficacy of rectal diclofenac versus indomethacin in the prevention of PEP. METHODOLOGY: This systematic review and meta-analysis adhered to the PRISMA guidelines and was prospectively registered in PROSPERO (CRD420251107055). Eligible studies directly compared rectal diclofenac versus indomethacin for PEP prevention in adults undergoing ERCP. A comprehensive search of five databases was performed through July 2025. Pooled risk ratios with 95% CIs were calculated using fixed- or random-effects models based on heterogeneity, and certainty of evidence was assessed using the GRADE approach.
resultsFour studies (three RCTs, one observational; n = 2,917) compared rectal diclofenac (n = 1,275) and indomethacin (n = 1,642) for PEP prevention. Baseline characteristics were comparable, except for less frequent balloon dilatation with diclofenac (RR 0.78, 95% CI 0.68-0.89; p < 0.001). No significant differences were found for overall PEP (RR 1.17, 95% CI 0.92-1.49; I
conclusionDiclofenac and indomethacin demonstrate equivalent efficacy and safety, allowing cost and availability to inform the choice of PEP prophylaxis.
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