ArticleDigestive diseases and sciences2026
Confounding by Indication in Real-World Indomethacin Use for Post-ERCP Pancreatitis: Implications for Severity and Cost.
Article in Digestive diseases and sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
aimsRectal indomethacin is recommended for PEP prevention, but real-world effectiveness may differ due to selective use in higher-risk patients. This study evaluated the association between indomethacin use and PEP, severity, and cost implications of selective versus routine prophylaxis.
methodsA retrospective cohort study of 332 ERCP procedures at a level III community hospital compared two endoscopists: selective versus routine administration. Firth penalized logistic regression evaluated PEP predictors. Severity was classified using Cotton and Revised Atlanta criteria. Cost analysis incorporated institutional acquisition and estimated hospitalization costs.
resultsIndomethacin was administered in 100 cases (30.1%). PEP occurred in 19 patients (5.7%), with no significant difference between groups. In adjusted analysis, indomethacin was not associated with PEP (odds ratio [OR] 1.26, 95% confidence interval [CI] 0.32-4.56, p = 0.74), while guidewire passage into the pancreatic duct (OR 5.25, p = 0.004) and prior PEP (OR 5.68, p = 0.001) were significant predictors. Indomethacin use was strongly associated with procedural difficulty, consistent with confounding by indication. Severe pancreatitis occurred only in the non-indomethacin group, though underpowered. Acquisition costs ranged from $262 to $532 per dose ($79-$160 per ERCP). At base-case PEP hospitalization cost of $20,000, mean total cost per ERCP was $1,263 for selective versus $1,173 for routine use; across all assumptions, costs were driven by PEP incidence rather than medication utilization.
conclusionIndomethacin use was driven by procedural risk factors and not independently associated with reduced PEP. Economic outcomes were more sensitive to complication rates than drug costs.
Indexed as
Identifiers
42573940What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.