Rectal indomethacin to prevent post-ERCP pancreatitis

In their article on the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP), Elmunzer et al. (April 12 issue)1 underemphasized the fact that prophylactic pancreatic stents were placed in more than 80% of the study patients, among whom clinical suspicion of sphincter of Oddi dysfunction was predominant. Pancreatic stents significantly reduce rates of pancreatitis in high-risk patients,2,3 and the average rate reduction is larger than that in the current trial. In addition, the diameter of the stents influences rates of pancreatitis4,5; the diameter of the stents used by Elmunzer et al. was not reported.