Diclofenac vs. Placebo in a Randomized Double Blind Controlled Trial in Post ERCP Pancreatitis

* All patients signed informed consents for the procedure, and the participation in the study. * Between June 2012 and June 2013, 199 patients fulfilled the inclusion criteria, 182 of whom were included in the final analysis. * Patients were excluded from study participation if they had a contraindication for diclofenac, including patients with recently diagnosed peptic ulcer disease, renal failure, those who developed acute pancreatitis during the two weeks before ERCP, those with a history of chronic pancreatitis, and those who did not agree to participate in the study. * A placebo-controlled trial was conducted in 182 patients who underwent ERCP. * Preoperative, the patients received 75 mg intramuscular(IM) diclofenac or IM normal saline as placebo. At the end of each procedure, the investigators recorded the details of the maneuvers performed, including: 1. the total time of the procedure, 2. the number of attempts at cannulation, 3. the number of pancreatic duct cannulation, 4. the final diagnosis by ERCP, 5. whether a sphincterotomy, a needle-knife papillotomy, or stent placement were performed. * Serum amylase was determined 12 hours after ERCP. * If the 12-hours serum amylase level was \> 3 times the upper normal limit and the patient exhibited pain or nausea and vomiting, then the patient had pancreatitis. * Acute pancreatitis was defined as serum amylase \> 3 times the upper limit of normal and associated with epigastric pain, back pain, and epigastric tenderness. * Statistical analysis: 1. Randomization was done by the GI nurse, concealed envelop 2. Data were summarized by descriptive statistics. 3. The Chi square was used to compare categorical patient data. 4. The Student's t test was used to compare continuous variables. 5. Two-tailed P \< 0.05 was considered to indicate significance.