Shuroog Nabhan, Abdullah Ajwah, Bassam Alsaeedi, Basel Alghamdi
Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP) and is a major source of ERCP procedure-related morbidity. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac and indomethacin are commonly used for PEP prophylaxis because of their anti-inflammatory properties. The aim of the present systematic review was to compare the efficacy of rectal diclofenac versus rectal indomethacin in preventing PEP. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, and studies were identified through a comprehensive search of databases covering the period from 2019 to 2025. Nine studies were included. The findings indicate that both rectal diclofenac and rectal indomethacin are effective prophylactic agents and significantly reduce the incidence of PEP. In conclusion, the available evidence supports the routine use of either rectal diclofenac or rectal indomethacin to prevent post-ERCP pancreatitis.