{"PubmedArticle":{"MedlineCitation":{"@attributes":{"Status":"Publisher","Owner":"NLM"},"PMID":{"@attributes":{"Version":"1"},"@text":"41961186"},"DateRevised":{"Year":"2026","Month":"04","Day":"10"},"Article":{"@attributes":{"PubModel":"Print-Electronic"},"Journal":{"ISSN":{"@attributes":{"IssnType":"Electronic"},"@text":"0975-0711"},"JournalIssue":{"@attributes":{"CitedMedium":"Internet"},"PubDate":{"Year":"2026","Month":"Apr","Day":"10"}},"Title":"Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology","ISOAbbreviation":"Indian J Gastroenterol"},"ArticleTitle":"The effectiveness of indomethacin and pancreatic duct stenting in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review and network meta-analysis.","ELocationID":[{"@attributes":{"EIdType":"doi","ValidYN":"Y"},"@text":"10.1007\/s12664-026-01974-w"}],"Abstract":{"AbstractText":[{"@attributes":{"Label":"BACKGROUND AND AIMS","NlmCategory":"OBJECTIVE"},"@text":"Endoscopic retrograde cholangiopancreatography (ERCP) has significant diagnostic and therapeutic roles in pancreaticobiliary disorders. Post-ERCP pancreatitis (PEP) is the most common adverse event that can be encountered and affects 1% to\u00a09% of the average-risk group and 11% to\u00a040% of the high-risk group. Several methods have been used to prevent PEP, including pancreatic duct (PD) stenting and pharmacological use, including indomethacin."},{"@attributes":{"Label":"METHODS","NlmCategory":"METHODS"},"@text":"We conducted a systematic review of PubMed (MEDLINE), Scopus and Web of Science (WOS) databases until November 1, 2024, using relevant keywords. Only randomized clinical trials (RCTs) were included. The network meta-analysis is reported using odds ratios (ORs) with 95% confidence intervals (CIs) with a significance level\u2009<\u20090.05. Rank probabilities were calculated using p-scores to rank treatments based on their effectiveness. All analyses were performed using R version 4.3.1 (2023-06-16 ucrt) with the netmeta package. The\u00a0Grading of Recommendations,\u00a0Assessment, Development and Evaluation (GRADE)\u00a0assessment of the certainty of the evidence was performed."},{"@attributes":{"Label":"RESULTS","NlmCategory":"RESULTS"},"@text":"Of 1828 references, total 31 RCTs with 9050 participants were included in this meta-analysis. Compared to placebo, indomethacin (OR\u2009=\u20090.50, 95% CI\u2009=\u20090.39-0.64, p\u2009<\u20090.001), PD stenting (OR\u2009=\u20090.33, 95% CI\u2009=\u20090.23-0.47, p\u2009<\u20090.001) and indomethacin combined with PD stenting (OR\u2009=\u20090.36, 95% CI\u2009=\u20090.18-0.73, p\u2009=\u20090.005) were effective in reducing PEP. Sub-group analysis of high-risk patients revealed similar results, indomethacin (OR\u2009=\u20090.43, 95% CI\u2009=\u20090.31-0.61, p\u2009<\u20090.001), PD stenting (OR\u2009=\u20090.32, 95% CI\u2009=\u20090.22-0.47, p\u2009<\u20090.001) and indomethacin combined with PD stenting (OR\u2009=\u20090.32, 95% CI\u2009=\u20090.14-0.72, p\u2009=\u20090.006). Notably, indomethacin did not show significant effects in mild, moderate or severe PEP. Notably, indomethacin showed significant benefit in the prevention of moderate-severe PEP only."},{"@attributes":{"Label":"CONCLUSIONS","NlmCategory":"CONCLUSIONS"},"@text":"The present network meta-analysis indicated that PD stenting seems to be the most effective in reducing PEP incidence among the examined treatments, particularly in high-risk patients, with inconsistent benefits of indomethacin in different PEP severities."}],"CopyrightInformation":"\u00a9 2026. Indian Society of Gastroenterology."},"AuthorList":{"@attributes":{"CompleteYN":"Y"},"Author":[{"@attributes":{"ValidYN":"Y"},"LastName":"Elshaar","ForeName":"Ahmed Gamal","Initials":"AG","AffiliationInfo":[{"Affiliation":"Faculty of Medicine, Menofia University, Shibin El Kom, Menofia, Egypt."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Samir","ForeName":"Ahmed Amir","Initials":"AA","AffiliationInfo":[{"Affiliation":"Faculty of Medicine, Al-Azhar University, Cario, Egypt."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Elgammal","ForeName":"Ahmed Samy","Initials":"AS","AffiliationInfo":[{"Affiliation":"Faculty of Medicine, Tanta University, Tanta, Egypt."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Elaw","ForeName":"Roaa Abdulrhman","Initials":"RA","AffiliationInfo":[{"Affiliation":"Faculty of Nursing, Damanhour University, Al-Buhyrah, Egypt."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Zain","ForeName":"Effa Afif","Initials":"EA","AffiliationInfo":[{"Affiliation":"Faculty of Medicine and Human Sciences, University of Aden, Aden, Yemen."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Bin-Sahel","ForeName":"Omer","Initials":"O","AffiliationInfo":[{"Affiliation":"Faculty of Medicine and Health Sciences, Seiyun University, Seiyun, Yemen."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Kamh","ForeName":"Nada Ramadan","Initials":"NR","AffiliationInfo":[{"Affiliation":"Faculty of Medicine, Tanta University, Tanta, Egypt."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Serag","ForeName":"Zahra Faried Farouq","Initials":"ZFF","AffiliationInfo":[{"Affiliation":"Faculty of Medicine, Al-Azhar University, Cario, Egypt."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Ramadan","ForeName":"Mohamed Diab","Initials":"MD","AffiliationInfo":[{"Affiliation":"Faculty of Medicine, Suez Canal University, Suez, Egypt."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Anber","ForeName":"Magdy Mostafa","Initials":"MM","AffiliationInfo":[{"Affiliation":"Tanta University Hospital, Tanta, Egypt."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Osama","ForeName":"Zainab","Initials":"Z","AffiliationInfo":[{"Affiliation":"Faculty of Medicine, Al Butana University, Gazira State, Ruffa City, Sudan."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Elgohary","ForeName":"Mohamed","Initials":"M","AffiliationInfo":[{"Affiliation":"Faculty of Medicine, Port Said University, Port Said, Egypt."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Ali","ForeName":"Hossam Tharwat","Initials":"HT","Identifier":[{"@attributes":{"Source":"ORCID"},"@text":"0000-0001-8077-5911"}],"AffiliationInfo":[{"Affiliation":"Qena Faculty of Medicine, Qena University, Qena, Egypt. Hossam.Tharwat@med.svu.edu.eg."}]}]},"Language":["eng"],"PublicationTypeList":{"PublicationType":[{"@attributes":{"UI":"D016428"},"@text":"Journal Article"},{"@attributes":{"UI":"D016454"},"@text":"Review"}]},"ArticleDate":[{"@attributes":{"DateType":"Electronic"},"Year":"2026","Month":"04","Day":"10"}]},"MedlineJournalInfo":{"Country":"India","MedlineTA":"Indian J Gastroenterol","NlmUniqueID":"8409436","ISSNLinking":"0254-8860"},"CitationSubset":["IM"],"KeywordList":[{"@attributes":{"Owner":"NOTNLM"},"Keyword":[{"@attributes":{"MajorTopicYN":"N"},"@text":"ERCP"},{"@attributes":{"MajorTopicYN":"N"},"@text":"Indomethacin"},{"@attributes":{"MajorTopicYN":"N"},"@text":"Network meta-analysis"},{"@attributes":{"MajorTopicYN":"N"},"@text":"Pancreatic duct stent"},{"@attributes":{"MajorTopicYN":"N"},"@text":"Post-ERCP pancreatitis"}]}],"CoiStatement":"Declarations. Conflicts of interest: AGE, AAS, ASE, RAE, EAZ, OBS, NRK, ZFFS, MDR, MMA, ZO, ME and HTA declare no competing interests. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Disclaimer: The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members,\u00a0the Indian Society of Gastroenterology or the printer\/publishers are responsible for the results\/findings and content of this article."},"PubmedData":{"History":{"PubMedPubDate":[{"@attributes":{"PubStatus":"received"},"Year":"2025","Month":"6","Day":"10"},{"@attributes":{"PubStatus":"accepted"},"Year":"2026","Month":"1","Day":"19"},{"@attributes":{"PubStatus":"medline"},"Year":"2026","Month":"4","Day":"10","Hour":"12","Minute":"59"},{"@attributes":{"PubStatus":"pubmed"},"Year":"2026","Month":"4","Day":"10","Hour":"12","Minute":"59"},{"@attributes":{"PubStatus":"entrez"},"Year":"2026","Month":"4","Day":"10","Hour":"11","Minute":"6"}]},"PublicationStatus":"aheadofprint","ArticleIdList":{"ArticleId":[{"@attributes":{"IdType":"pubmed"},"@text":"41961186"},{"@attributes":{"IdType":"doi"},"@text":"10.1007\/s12664-026-01974-w"},{"@attributes":{"IdType":"pii"},"@text":"10.1007\/s12664-026-01974-w"}]},"ReferenceList":[{"Reference":[{"Citation":"Adler DG, Baron TH, Davila RE, et al. 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