Indomethacin and lactated Ringer’s hydration to prevent post-ERCP pancreatitis: right combination but wrong volume

We read with interest the recent study by Mok et al1 describing the role of rectal indomethacin combined with lactated Ringer's solution (LR) infusion to prevent post-ERCP pancreatitis (PEP). The investigators' strategy to combat PEP by using 2 potentially synergistic agents with different mechanisms of action draws parallels to the very successful strategy of using multidrug cocktails to treat the human immunodeficiency virus and more recently hepatitis C.2,3 Rectal indomethacin has been proved to prevent pancreatitis in high-risk cases and may have a role for average-risk procedures.

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