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As physicians with a long-time interest in the pharmacoprophylaxis of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), we greatly enjoyed reading the excellent meta-analysis performed by Elmunzer et al (Gut 2008;57:1262–7) based on four randomised clinical trials (RCTs). The analysis demonstrated a pooled relative risk (RR) for PEP of 0.36 (95% confidence interval (CI) 0.22 to 0.60) after prophylactic rectal administration of non-steroidal anti-inflammatory drugs (NSAIDs), with a relative risk (RR) of 0.30 (95% CI 0.01 to 0.76) for moderate and severe pancreatitis. The authors concluded that rectal administration of NSAIDs is effective in preventing PEP. While these results have significant clinical implications, several issues remain unsolved. For …
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