Indomethacin vs Diclofenac for Preventing PEP

NCT ID: NCT07071441

Last Updated: 2025-12-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

4050 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-06-01

Study Completion Date

2026-12-31

Brief Summary

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Pancreatitis is the most common and serious complication following post-endoscopic retrograde cholangiopancreatography (ERCP) and is associated with occasional mortality, extended hospital stays, and increased healthcare expenses. Preprocedural administration of rectal non-steroidal anti-inflammatory drugs (NSAIDs) was demonstrated to be an effective and convenient strategy for post-ERCP pancreatitis (PEP). Furthermore, several meta-analyses found that only 100mg indomethacin and diclofenac could effectively reduce PEP. Therefore, updated international clinical practice guidelines uniformly recommended administration of 100mg indomethacin or diclofenac in patients without contradictions. However, it was unclear which one of the two drug is more superior.

A recent meta-analysis suggested 100mg rectal diclofenac was more efficacious than same-dose rectal indomethacin in PEP prevention (relative risk (RR) 0·59, 95% confidence intervals (CI) 0·40-0·89). Based on the results, we conducted a multicenter, double-blind, control trial to investigate whether 100mg diclofenac is superior than same-dose indomethacin. This trial planned to enroll 3612 patients in total. However, in the first interim analysis, PEP occurred in 53 patients (8.8%) of 600 patients allocated to diclofenac group and 37 patients (6.1%) of 604 patients allocated to indomethacin group (relative risk (RR) 1.44; 95% confidence interval (CI) 0.96-2.16, p=0.074). Thus, the trial was stopped according to the futility rule of conditional power. However, it was worth noticing that PEP tended to be higher in diclofenac group than that in indomethacin group. A sample size of 1204 was under power to draw the conclusion of significantly lower PEP rate in indomethacin group and thus a new trial with larger sample size of sufficient power is predicted to prove the superiority of indomethacin over diclofenac. Here we conducted a multicenter, randomized, double-blind trial to investigate whether 100mg indomethacin is superior to 100mg diclofenac in preventing PEP.

Detailed Description

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Conditions

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ERCP Pancreatitis Non-steroidal Anti-inflammatory (NSAID) Indomethacin Diclofenac

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Indomethacin

All patients without contraindications should receive 100mg rectal indomethacin within 30mins before ERCP procedure

Group Type EXPERIMENTAL

Indomethacin 100 MG

Intervention Type DRUG

All patients without contraindications should receive 100mg rectal indomethacin within 30mins before ERCP procedure

Diclofenac group

All patients without contraindications should receive 100mg rectal diclofenac within 30mins before ERCP procedure

Group Type ACTIVE_COMPARATOR

Diclofenac 100mg

Intervention Type DRUG

All patients without contraindications should receive 100mg rectal diclofenac within 30mins before ERCP procedure

Interventions

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Indomethacin 100 MG

All patients without contraindications should receive 100mg rectal indomethacin within 30mins before ERCP procedure

Intervention Type DRUG

Diclofenac 100mg

All patients without contraindications should receive 100mg rectal diclofenac within 30mins before ERCP procedure

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* 18-90 years old patients with native papilla who planned to undergo ERCP

Exclusion Criteria

* Previous biliary sphincterotomy and papillary large balloon dilation
* Planned for placements of pancreatic duct stents (eg. pancreatic duct strictures, planned ampullectomy)
* Allergy to NSAIDs
* The administration of NSAIDs within 7 days
* Not suitable for NSAIDs administration (gastrointestinal hemorrhage within 4 weeks, renal dysfunction \[Cr \>1.4mg/dl=120umol/l\]; presence of coagulopathy before the procedure)
* Acute pancreatitis within 7 days before ERCP or acute pancreatitis with obvious Pancreatic edema and peripancreatic fluid collections
* Hemodynamical instability
* Pregnancy or lactation
* Unable to give informed consent
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Air Force Military Medical University, China

OTHER

Sponsor Role lead

Responsible Party

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Yanglin Pan

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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The 960th Hospital of the PLA

Jinan, Shandong, China

Site Status RECRUITING

The first medical center, Chinese PLA General Hospital

Beijing, Beijing Municipality, China

Site Status RECRUITING

The Second Affiliated Hospital of Chongqing Medical University

Chongqing, Chongqing Municipality, China

Site Status RECRUITING

Department of Gastroenterology, Hongai Hospital

Xiamen, Fujian, China

Site Status RECRUITING

Harbin Medical University Affiliated Fourth Hospital

Harbin, Heilongjiang, China

Site Status RECRUITING

[email protected]

Harbin, Heilongjiang, China

Site Status RECRUITING

Huaihe Hospital of Henan University

Kaifeng, Hennan, China

Site Status RECRUITING

Renmin hospital of Wuhan University

Wuhan, Hubei, China

Site Status RECRUITING

Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology

Wuhan, Hubei, China

Site Status RECRUITING

The Third Xiangya Hospital of Central South University

Changsha, Hunan, China

Site Status NOT_YET_RECRUITING

Jilin Miniciple People'S Hospital

Jilin, Jilin, China

Site Status RECRUITING

Qinghai University Affiliated Hospital

Xining, Qinghai, China

Site Status NOT_YET_RECRUITING

986 Hospital of Xijing Hospital

Xi'an, Shaanxi, China

Site Status RECRUITING

Second Affiliated Hospital of Xi'an Jiaotong University

Xi'an, Shaanxi, China

Site Status RECRUITING

Xijing Hospital of Digestive Diseases

Xi'an, Shaanxi, China

Site Status RECRUITING

Shandong Provincial Third Hospital

Jinan, Shandong, China

Site Status NOT_YET_RECRUITING

Eastern Hepatobiliary Surgery Hospital

Shanghai, Shanghai Municipality, China

Site Status RECRUITING

Affiliated Hangzhou First People's Hospital

Hangzhou, Zhejiang, China

Site Status NOT_YET_RECRUITING

the First Affiliated Hospital, Zhejiang University School of Medicine

Hangzhou, Zhejiang, China

Site Status RECRUITING

the second Affiliated Hospital, Zhejiang University School of Medicine

Hangzhou, Zhejiang, China

Site Status NOT_YET_RECRUITING

Countries

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China

Central Contacts

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Yanglin Pan, MD

Role: CONTACT

86-84771536

Facility Contacts

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Yaqi Zhai

Role: primary

86-13810105934

Bo Ning

Role: primary

86-13996476336

Rongchun Zhang, MD

Role: primary

+8618841185362

Liguo Wang

Role: primary

86-13654553324

Lei Zhao

Role: primary

86-18745143401

Jianghai Zhao

Role: primary

86-13700782780

Xinyue Wan

Role: primary

86-13986265930

Bing Wang

Role: primary

86-13307171656

Zhao Lei

Role: primary

86-13469438509

Xiang Guo

Role: primary

86-18104421678

Li Ren

Role: primary

86-18997291606

Jun Wang

Role: primary

86-13669252896

Gang Zhao

Role: primary

86-13892867489

Ming zhang

Role: primary

86-13791112618

Xiaofeng Liu

Role: primary

86-13969179611

Mingxing Xia

Role: primary

86-13906524284

Xiaofeng Zhang

Role: primary

86-13758250208

Kangjie Chen

Role: primary

86-18989487755

Jiamin Chen

Role: primary

86-13505811655

References

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Akshintala VS, Sperna Weiland CJ, Bhullar FA, Kamal A, Kanthasamy K, Kuo A, Tomasetti C, Gurakar M, Drenth JPH, Yadav D, Elmunzer BJ, Reddy DN, Goenka MK, Kochhar R, Kalloo AN, Khashab MA, van Geenen EJM, Singh VK. Non-steroidal anti-inflammatory drugs, intravenous fluids, pancreatic stents, or their combinations for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and network meta-analysis. Lancet Gastroenterol Hepatol. 2021 Sep;6(9):733-742. doi: 10.1016/S2468-1253(21)00170-9. Epub 2021 Jun 30.

Reference Type BACKGROUND
PMID: 34214449 (View on PubMed)

Dumonceau JM, Kapral C, Aabakken L, Papanikolaou IS, Tringali A, Vanbiervliet G, Beyna T, Dinis-Ribeiro M, Hritz I, Mariani A, Paspatis G, Radaelli F, Lakhtakia S, Veitch AM, van Hooft JE. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2020 Feb;52(2):127-149. doi: 10.1055/a-1075-4080. Epub 2019 Dec 20.

Reference Type BACKGROUND
PMID: 31863440 (View on PubMed)

Kang X, Xia M, Wang J, Wang X, Luo H, Qin W, Liang Z, Zhao G, Yang L, Sun H, Tao J, Ning B, Zhong L, Zhang R, Ma X, Zhao J, Yue L, Jin H, Kang C, Ren G, Liang S, Wang H, Wang L, Nie Y, Wu K, Fan DM, Pan Y. Rectal diclofenac versus indomethacin for prevention of post-ERCP pancreatitis (DIPPP): a multicentre, double-blind, randomised, controlled trial. Gut. 2025 Jun 6;74(7):1094-1102. doi: 10.1136/gutjnl-2024-334466.

Reference Type BACKGROUND
PMID: 40113243 (View on PubMed)

Luo H, Zhao L, Leung J, Zhang R, Liu Z, Wang X, Wang B, Nie Z, Lei T, Li X, Zhou W, Zhang L, Wang Q, Li M, Zhou Y, Liu Q, Sun H, Wang Z, Liang S, Guo X, Tao Q, Wu K, Pan Y, Guo X, Fan D. Routine pre-procedural rectal indometacin versus selective post-procedural rectal indometacin to prevent pancreatitis in patients undergoing endoscopic retrograde cholangiopancreatography: a multicentre, single-blinded, randomised controlled trial. Lancet. 2016 Jun 4;387(10035):2293-2301. doi: 10.1016/S0140-6736(16)30310-5. Epub 2016 Apr 28.

Reference Type BACKGROUND
PMID: 27133971 (View on PubMed)

Other Identifiers

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KY20242439-F-1

Identifier Type: -

Identifier Source: org_study_id

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