Are all post-ESWL pancreatitis events clinically significant?

We read with interest the Article by Yang-Yang Qian and colleagues 1 Qian YY Ru N Chen H et al. Rectal indometacin to prevent pancreatitis after extracorporeal shock wave lithotripsy (RIPEP): a single-centre, double-blind, randomised, placebo-controlled trial. Lancet Gastroenterol Hepatol. 2022; 7: 238-244 Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar that focused attention on the prevention of pancreatitis after extracorporeal shock wave lithotripsy (ESWL). ESWL or endoscopic therapy is regarded as the first-line treatment for patients with painful chronic pancreatitis. Rectal indometacin to prevent pancreatitis after extracorporeal shock wave lithotripsy (RIPEP): a single-centre, double-blind, randomised, placebo-controlled trialPre-procedural administration of rectal indometacin is an efficacious and safe means of reducing the incidence of post-ESWL pancreatitis. Full-Text PDF Are all post-ESWL pancreatitis events clinically significant? – Authors' replyWe thank Aniruddha Singh and colleagues for their interest in the RIPEP study,1 and we welcome the opportunity to discuss these issues. We acknowledge the important work Singh and colleagues have done on the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) in over 5000 patients.2 The relatively high incidence of post-ESWL pancreatitis in our study might be attributed to the following aspects. The revised Atlanta consensus classification used in the RIPEP study standardised reporting of acute pancreatitis using easily identified clinical and radiological criteria, and the application in the definition of post-ESWL pancreatitis needs validation, as the consensus criteria are widely used in endoscopic retrograde cholangiopancreatography (ERCP) guidelines. Full-Text PDF