What explains the contradictory results of nonsteroidal anti-inflammatory drugs (NSAIDS) in prophylaxis for Post-ERCP Pancreatitis (PEP)?

Background: The 2010 ESGE guideline recommended the use of NSAIDs for prophylaxis of PEP, but this recommendation was not accepted widely. Controversies were raised by publications in which NSAIDs were found ineffective against PEP. After a thorough literature overview, we concluded that NSAIDs seem to be ineffective in cases with too many cannulation attempts and early precut can prevent from unsuccessful trials. Aim of our study was to test our biliary intubation protocol with early precut and to find those patients benefiting from the use of NSAIDs for prevention of PEP. Methods: A total of 539 patients with…