الفهرس 
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Abstract
Pancreatitis is one of the major complications of endoscopic retrograde cholangiopancreatography (ERCP) . It occurs in 1–10 % of patients but the incidence may reach 25 % in high-risk patient populations.
PEP is associated with increased morbidity, mortality, and health care costs. This has led to a number of studies evaluating the efficacy of pharmacologic prophylaxis in the prevention of PEP.
The main aim of the studyis to find which is better as pharmacological prophylaxis of post ERCP pancreatitis indomethacine or nitroglycerine.
The study included 48 patients underwent ERCP for diagnostic and therapeutic Indications , common bile duct stones and cancer head of pancreas were the most commonly encountered diagnosis . The first group of patients did not receive any drugs , The second group of patients received rectal indomethacine 100 mg immediately after ERCP , The third group of patients received nitroglycerine skin patch 10 mg at least 30 minutes before ERCP .
Most of the patients of our study had elevated total and direct bilirubin with the mean value of 8.7mg/dl and 7.2mg/dl respectively and also most of patients in the study had elevated liver enzymes with mean value of 91u/l for A.L.T and 100 u/l for A.S.T , Alkaline phosphatase is elevated in patients of the study with the mean of 585 u/l , But Serum amylase and lipase levels were normal before ERCP with mean value 50 u/l for amylase and 45 u/l for serum lipase .
All case in the studied groups during ERCP shows dilated C.B.D and IHBRD except one case in the control group.
While doing ERCP stone extraction was done for patients presented with calcular obstructive jaundice using dormia basket and/or extraction ballon with dilatation of C.B.D stricture using dilator ballon followed by plastic stent deployment in C.B.D or metal stent in the presence of cancer pancreas .
All patients of the study were observed clinically after doing ERCP with measurement of serum amylase and lipase 24 hours after the procedure.
In our study , one patient from the control group developed PEP and presented with epigastric pain , vomiting with elevated serum amylase level ( 1676 u/l ) and serum lipase level( 1852 u/l ), the patient admitted for one week and according to the classification of PEP it was moderate pancreatitis by wang et al., 2009 and the patient received ( I.V fluids , anagesics, proton pump inhibitor , antibiotics , sandostatin and antiemetic ) and improved on treatment .
The incidence of pancreatitis in this study was 6.25 %. While no recorded case of PEP in either indomethacin group or nitroglycerine group.