Rectal Indomethacin Administration Is Associated with a Lower Prevalence of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis in Children: An Observational Cohort Study

Monique T Barakat; Roberto Gugig

doi:10.1016/j.jpeds.2026.114990

Rectal Indomethacin Administration Is Associated with a Lower Prevalence of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis in Children: An Observational Cohort Study

J Pediatr. 2026 Jan 14:294:114990. doi: 10.1016/j.jpeds.2026.114990. Online ahead of print.

Authors

Monique T Barakat¹, Roberto Gugig²

Affiliations

¹ Division of Pediatric Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA; Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA.
² Division of Pediatric Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA. Electronic address: rgugig@stanford.edu.

PMID: 41544752
DOI: 10.1016/j.jpeds.2026.114990

Abstract

Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) rates are higher in children than adults, for whom PEP prophylaxis with rectal indomethacin is standard of care. We analyzed the records of children undergoing endoscopic retrograde cholangiopancreatographies performed during indomethacin unavailability and found the PEP rate was 11.1% when this medication was unavailable vs 3.6% when it was used (P < .001) in age- and complexity-matched groups. Rectal administration of indomethacin appears safe and effective for pediatric PEP prophylaxis.

Keywords: endoscopic retrograde cholangiopancreatography (ERCP); indomethacin; pediatric; post-ERCP pancreatitis.