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Updated: Nov 30, 2025
An Obstructive Chronic Pancreatitis Model Established Through Electrocoagulation
Published on: October 31, 2025
Emerging Therapies to Prevent Post-ERCP Pancreatitis
Nikhil R Thiruvengadam1,2, Michael L Kochman3,4
1Division of Gastroenterology and Hepatology, University of California San Francisco, 513 Parnassus Avenue, S-357, Box 0538, San Francisco, CA, 94143-0538, USA. Nikhil.Thiruvengadam@ucsf.edu.
Purpose Of Review:
The aim of this review is to evaluate emerging, novel therapies for the prevention of post-ERCP pancreatitis.
Recent Findings:
Rectal indomethacin reduces the risk of pancreatitis in low- and average-risk patients, who comprise the majority of patients undergoing ERCP. An 8-h protocol of aggressive lactated Ringer's reduces the risk of pancreatitis in average-risk patients. Sublingual nitrate may provide additional benefit to rectal NSAIDs in preventing PEP. A tacrolimus trough > 2.5 ng/mL was recently shown to be associated with a lower risk of PEP in liver transplant patients undergoing ERCP. Routine usage of rectal indomethacin in all patients undergoing ERCP reduces the risk of PEP. Pancreatic-duct stents reduce the risk of PEP in high-risk patients. There is emerging data that aggressive hydration with lactated Ringer's and nitrates may further reduce PEP. Tacrolimus is a promising potential agent to prevent PEP but needs further clinical study.
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