The role of rectal nonsteroidal anti-inflammatory drugs (NSAIDs) for preventing pancreatitis in average-risk endoscopic retrograde cholangiopancreatography (ERCP) cases remains controversial. Although the European Society of Gastrointestinal Endoscopy recommends rectal indomethacin or diclofenac for all patients undergoing ERCP,1 the American Society for Gastrointestinal Endoscopy has endorsed their use only in high-risk cases.2 Adding to this controversy is the randomized trial by Levenick et al3 suggesting that rectal indomethacin is ineffective in consecutive (largely average-risk) patients undergoing ERCP at a single academic institution in the United States.