Nikhil Thiruvengadam

Lowering the risk of post-ERCP pancreatitis

after the procedure. Luo et al demonstrated a 50% decrease in PEP by routinely using rectal indomethacin as opposed to using it only in selected high-risk patients. Routine rectal indomethacin use is a simple, safe, inexpensive modality to decrease PEP as the most frequent adverse event of ERCP. Although the authors make a compelling argument for the use of rectal indomethacin for “highrisk” patients, we must remember that the risks for PEP are additive, encompassing a spectrum of patient and technical factors. Perhaps the gap between “average-risk” and “high-risk” patients for PEP remains smaller in practice than is statistically elucidated. Therefore, the use of routine precautionary measures such as rectal indomethacin should be the new standard of care.