Introduction ERCP has become a standard therapeutic procedure for the management of biliary and pancreatic pathology. ERCP is associated with complications, especially pancreatitis (3–7%), bleeding (1%) and perforation (1%). Several recent meta-analyses indicate that rectal NSAID may reduce post-ERCP pancreatitis (PEP) by up to 50% vs placebo.

Aim To assess the impact of the selective use of rectal Indomethacin prophylaxis on PEP.

Method Single centre study over 3 years: Oct 2011 to Oct 2014. Analysis of 404 consecutive patients undergoing ERCP by single operator. In first 2 years Indomethacin prophylaxis was not used; in 3rd year Indomethacin 100mg per rectum was given post procedure at endoscopist’s discretion if patient considered at high risk of PEP. The endoscopy database and patient electronic records were analysed using Microsoft Excel 2010 and GraphPad Prism v6.

Conclusion ERCP is essentially a therapeutic procedure with successful outcome in >95% of cases. The pancreatitis rate has dropped from 4% to 2.32% since the introduction of indomethacin prophylaxis. Although this reduction is not statistically significant it is encouraging and in line with recently published European guidelines (ESGE June 2014) which recommend routine use of rectal NSAID for all ERCP cases.

Disclosure of interest None Declared.