Indomethacin for post-ERCP pancreatitis prophylaxis: another attempt at the Holy Grail.

Acute pancreatitis continues to be the most dreaded complication after ERCP. Various risk factors for post-ERCP pancreatitis have now been recognized including patient-related, procedure-related, and operator-related factors. Numerous attempts at finding the ideal pharmacological agent for prevention of this complication have been made but nearly all drugs evaluated have failed to demonstrate clinical efficacy. Predictably, these agents have shown promise in early single-center studies but met with disappointing results when tested in larger multicenter randomized controlled trials. As the quest for the "magic bullet" continues, selecting patients with appropriate indications for ERCP and prophylactic pancreatic duct stenting in high-risk cases appears to be the best approach to averting this complication.