We thank Elmunzer and Waljee for their excellent synopsis of our article, critical review of its methodology, and interpretation of the results. Of course our study was inspired by the randomized, controlled trial of nonsteroidal anti-inflammatory drugs (NSAIDs) versus placebo for prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP; N Engl J Med 2012;366:1414–1422). However, in that study >80% of patients in each arm underwent prophylactic stent placement (PSP) and thus it was not an NSAID alone versus placebo alone trial. Since the publication of a post hoc analysis of the NEJM data (Am J Gastroenterol 2013;108:410–415) and indirect network meta-analysis (Clin Gastroenterol Hepatol 2013;11:778–783), the approach to use of NSAIDs to prevent PEP has varied within our own practice at Mayo Clinic, Rochester. Our ERCP practice employs the services of 6 ERCPists, all of whom now administer rectal NSAIDs but without a uniform approach. Some believe in using NSAIDs alone, whereas others are uncomfortable withholding PSP. Among our group's practice, the approach to use of NSAIDs alone or PSP combined with NSAIDs varies not only between endoscopists, but within endoscopists, depending on the individual patient. Although we have not adopted the approach to administer NSAIDs to low-risk patients, one could argue that if ERCPists have a “zero tolerance policy” with regard to PEP, NSAIDs should be administered to all patients undergoing ERCP. In addition, one-time administration of rectal NSAIDs is low cost and low risk for adverse events, further supporting its potential for uniform administration. We eagerly await the results of the randomized trial of NSAIDs alone and stents alone, understanding that participating centers may find it difficult to enroll patients who may be randomized to not receive PSP. Not only do we encourage centers to participate in the randomized controlled trial, but also encourage centers to collect data prospectively during clinical practice that could also provide useful additional information on NSAIDS and PEP. Dr Baron is currently affiliated with the Division of Gastroenterology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina. Can Rectal NSAIDs Replace Prophylactic Pancreatic Stent Placement for the Prevention of Post-ERCP Pancreatitis?GastroenterologyVol. 146Issue 1PreviewAkbar A, Abu Dayyeh BK, Baron TH, et al. Rectal nonsteroidal anti-inflammatory drugs are superior to pancreatic duct stents in preventing pancreatitis after endoscopic retrograde cholangiopancreatography: a network meta-analysis. Clin Gastroenterol Hepatol 2013;11:778–783. Full-Text PDF