Single-Dose NSAIDs in ERCP: Gastroenterology | May 2026

Introduction

Post-ERCP pancreatitis (PEP) remains one of the most common and serious complications of Endoscopic Retrograde Cholangiopancreatography. Rectal NSAIDs such as Indomethacin and Diclofenac are strongly recommended for PEP prevention. However, concerns about renal safety—especially in elderly patients and those with chronic kidney disease—have limited their widespread use in clinical practice.

This large multicenter prospective study evaluates whether a single peri-procedural dose of NSAIDs truly increases the risk of kidney injury, addressing an important clinical hesitation.

Problem Statement

Despite strong evidence supporting NSAIDs in reducing PEP, many clinicians avoid their use due to fear of acute kidney injury (AKI) or acute kidney disease (AKD). Current guidelines often recommend caution or avoidance in patients perceived to be at higher renal risk.

This creates a clinical dilemma:

👉 Should we compromise effective PEP prevention due to theoretical renal risks, or is this concern overstated?

Summary

In a large cohort of over 11,000 patients undergoing ERCP, approximately half received a single dose of rectal NSAIDs. The study found:

No significant association between NSAID use and AKI or AKD

Low absolute rates of kidney injury (0.5%–0.8%), even in high-risk groups

Consistent findings across:

Elderly patients

Patients with pre-existing chronic kidney disease

Propensity-matched analysis

Importantly, NSAIDs were also not associated with increased bleeding or other major adverse events.

These findings suggest that single-dose NSAIDs are safe from a renal standpoint in the ERCP setting, challenging the routine avoidance of these drugs.