Rectal Indomethacin and Oral Tacrolimus Versus Combination to Prevent Post-ERCP Pancreatitis

This study compares three approaches to preventing pancreatitis (inflammation of the pancreas) after ERCP — a procedure used to diagnose and treat bile duct problems. Post-ERCP pancreatitis is the most common and serious complication of this procedure. The three approaches being tested are: rectal indomethacin alone, oral tacrolimus alone, or both drugs combined. You may be eligible if: - You are 18 years or older - You are scheduled to undergo an ERCP procedure at a participating center - You are able to consent to participate You may NOT be eligible if: - You are pregnant or breastfeeding - You have chronic calcific pancreatitis - You have had a prior biliary sphincterotomy (unless a pancreatogram is still planned) - You have active pancreatitis within the last 30 days - You have cancer in the head of the pancreas - You have chronic kidney disease with very low kidney function (GFR below 30) - You have a known contraindication to tacrolimus or NSAIDs - You are currently taking tacrolimus or immune modulators - You have Sphincter of Oddi dysfunction Type 3 - You do not have a rectum Talk to your doctor to see if this trial is right for you.