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Editorial:Pharmacologic Prophylaxis Alone Is Not Adequate to Prevent Post-ERCP Pancreatitis

Arain, Mustafa A MD1; Freeman, Martin L MD1

American Journal of Gastroenterology: June 2014 - Volume 109 - Issue 6 - p 910–912
doi: 10.1038/ajg.2014.123
Pancreas and Biliary Tract

Post-ERCP pancreatitis (PEP) remains the most common complication following ERCP. Although once considered unpredictable, understanding patient and procedure-related risk factors, and measures such as pancreatic stent placement and pharmacoprophylaxis have been shown to substantially decrease the risk of PEP. In this issue of the Journal, the role of pharmacoprophylaxis is explored in a study comparing rectal indomethacin plus sublingual nitrates vs. rectal indomethacin alone. While showing improved efficacy, dual pharmacoprophylaxis does not appear adequate to obviate the importance of technique-related variables and pancreatic stents. Rather, a comprehensive approach is likely to be the most efficacious strategy to reduce PEP.

1 Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA

Correspondence: Mustafa A. Arain MD, Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, 406 Harvard St SE, MMC36, Minneapolis, Minnesota 55455, USA. E-mail: or

Received 29 March 2014; accepted 4 April 2014

© The American College of Gastroenterology 2014. All Rights Reserved.
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