Is it possible to choose where the pipe output is inserted into Elixir function args?

You can simply bind to a variable to capture your first result and then replace it in the second List.update_at/3 call

def update_2d(array, inds = [first_coord, second_coord], val) do
  updated =
    array
    |> Enum.at(second_coord) 
    |> List.update_at(first_coord, fn(x) -> val end)

    List.update_at(array, second_coord, fn(x) -> updated end)
end

You can also use the capture operator to do this:

  def update_2d(array, inds = [first_coord, second_coord], val), do:    
    array
    |> Enum.at(second_coord) 
    |> List.update_at(first_coord, fn(x) -> val end)
    |> (&(List.update_at(array, second_coord, fn(y) -> &1 end))).()

I find using a variable much more readable, but the option is there.