Response:

We thank Hakuta et al1 for their interest in and comments on our study.2 We agree that repeated guidewire cannulation of the pancreatic duct may increase the risk of post-ERCP pancreatitis. Although there is some debate on this isssue, we think that successful insertion of a prophylactic pancreatic stent, inadvertent cannulation of the side branches of the pancreatic duct, and injection of contrast material are among the determining factors. Additionally, there is some controversy about the timing of pancreatic stent insertion, which usually depends on the preference of the endoscopists.

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