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[Comment] Simple pharmacological prophylaxis for post-ERCP pancreatitis

Pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) is a serious complication that, at the minimum, prolongs hospital stay and, in rare cases, causes serious morbidity and death.1 The potential for risk reduction through pharmacological prophylaxis has therefore been the subject of extensive investigation. Published data generally support the use of rectal indometacin to reduce the risk of post-ERCP pancreatitis.2–4 However, studies on this topic differentiate themselves on two clinically relevant fronts: the timing of indometacin administration (before vs after the ERCP procedure), and patient selection (administration to all patients provided no contraindications to non-steroidal anti-inflammatory drugs [NSAIDs] vs administration only to patients at high risk of post-ERCP pancreatitis).