The best plastic pancreatic stent to prevent post-ERCP pancreatitis.

We consider very interesting the comments made by Serrano Díaz et al. on pancreatic stents inserted as prophylaxis for acute post-ERCP pancreatitis. As we recently stated in an editorial related to the prevention of this frequent complication, the aggressive way in which the pancreatic gland may respond to contact with the devices that are used for common bile duct cannulation via the papilla of Vater is almost philosophically surprising. It is our opinion that, usually, a pancreatic stent should only be inserted if the guidewire has spontaneously entered the main pancreatic duct (MPD). In ERCPs aiming at bile duct drainage, even when bile duct cannulation has been troublesome with extensive papillary manipulation, attempting cannulation of the MPD with the sole purpose of stent insertion can be more harmful than beneficial.