We read with great interest the article by Levenick et al,1 who evaluated the efficacy of indomethacin given via the rectal route in preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in a randomized controlled trial of patients undergoing ERCP. They concluded that rectal indomethacin did not prevent PEP. These are impressive findings that raise 2 important issues.