{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:39:37Z","timestamp":1789000777176,"version":"build-2803163510"},"reference-count":21,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Peri\u2010procedural rectal indomethacin was shown to decrease the incidence of post\u2010endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in adults undergoing ERCP. This practice was generalized to pediatric populations, despite an absence of data on safety or efficacy. This study evaluated the safety and efficacy of rectal indomethacin in pediatric patients undergoing ERCP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective, cohort study of pediatric patients undergoing ERCP (single\u2010endoscopist) at two tertiary academic hospitals from November 2009 to August 2024. Safety outcomes included bleeding and acute kidney injury (AKI). The efficacy outcome was incidence of PEP with and without indomethacin at 100\u2009mg\u2009&gt;\u200930\u2009kg and 50\u2009mg\u2009&lt;\u200930\u2009kg. Descriptive statistics, univariate analysis, and binary logistic regression adjusting for 18 covariates were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 906 ERCPs were performed in 448 patients. Indomethacin was administered in 757 (83.6%) procedures and not in 148 (16.3%). Bleeding occurred in 3.2% versus 3.4% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.90), and AKI in 1.1% versus 0.7% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.67). PEP incidence was 3.0% with indomethacin versus 9.5% without (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). On multivariate analysis, indomethacin significantly reduced PEP (odds ratio [OR]\u2009=\u20090.28, 95% confidence interval [CI] [0.11\u20130.71],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05; absolute risk reductions [ARR]\u2009=\u20096.5%; number needed to treat [NNT]\u2009=\u200916) without increasing bleeding or AKI. Findings were similar in subgroup analysis of index ERCPs with no increased odds of bleeding or AKI and significantly lower odds of PEP (OR\u2009=\u20090.16, 95%CI[0.05\u20130.53],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05; ARR\u2009=\u200912.7%; NNT\u2009=\u20098).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The use of peri\u2010procedural rectal indomethacin was safe and effective, with no increased bleeding or AKI and a greater than threefold reduction in PEP in pediatric patients. These findings support the use of indomethacin prophylaxis in pediatric patients at 100\u2009mg\u2009&gt;\u200930\u2009kg and 50\u2009mg\u2009&lt;\u200930\u2009kg.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jpn3.70427","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T05:59:37Z","timestamp":1774936777000},"page":"1509-1515","source":"Crossref","is-referenced-by-count":1,"title":["Safety and efficacy of rectal indomethacin for prevention of post\u2010endoscopic retrograde cholangiopancreatography pancreatitis in pediatric patients"],"prefix":"10.1002","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4385-7261","authenticated-orcid":false,"given":"Mary C.","family":"Camacho","sequence":"first","affiliation":[{"name":"Department of Medicine Emory University School of Medicine Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Blythe","sequence":"additional","affiliation":[{"name":"Health Services Research Center Emory University School of Medicine Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. Joseph","family":"Elmunzer","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology &amp; Center for Digestive Health and Surgery Atrium Health\u2010Wake Forest University Charlotte North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine","family":"Odiase","sequence":"additional","affiliation":[{"name":"Children's Healthcare of Atlanta Emory University School of Medicine Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devika","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Digestive Diseases Emory University Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Fritzen","sequence":"additional","affiliation":[{"name":"Children's Healthcare of Atlanta Emory University School of Medicine Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reuven Zev","family":"Cohen","sequence":"additional","affiliation":[{"name":"Children's Healthcare of Atlanta Emory University School of Medicine Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cary","family":"Sauer","sequence":"additional","affiliation":[{"name":"Children's Healthcare of Atlanta Emory University School of Medicine Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7071-3001","authenticated-orcid":false,"given":"Field F.","family":"Willingham","sequence":"additional","affiliation":[{"name":"Children's Healthcare of Atlanta Emory University School of Medicine Atlanta Georgia USA"},{"name":"Department of Medicine, Division of Digestive Diseases Emory University Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-023-04392-5"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1111103"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-015-4105-1"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000002632"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(04)00353-0"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.15038"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000003766"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2022.10.005"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-015-0314-2"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2017.01.033"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.5152\/tjg.2015.6000"},{"issue":"5","key":"e_1_2_9_13_1","article-title":"Aggressive 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