Endoscopic retrograde cholangiopancreatography (ERCP) remains one of the most challenging procedures that is associated with the highest risk of adverse events (mainly acute pancreatitis), including mortality.1 There is widespread acknowledgement that ERCP is an operator-dependent, technically challenging procedure that requires unique technical, cognitive, and integrative skills.2 There are limited and conflicting data regarding the safety of ERCP procedures with trainee involvement, especially among ERCPs deemed to be at high-risk for post-ERCP adverse events.3-7 Although a variety of risk factors have been demonstrated to increase the risk of post-ERCP pancreatitis (PEP), predictors of serious adverse events among ERCPs with trainee involvement have not been adequately described. Understanding these patient- and procedure-related variables could inform the development of algorithms and prediction tools that can help tailor the approach to training in ERCP, thereby increasing the safety of the training environment. There have been numerous advances to mitigate the risk of PEP. The recent Stent Versus Indomethacin (SVI) trial demonstrated that the strategy of indomethacin alone was not as effective as a strategy of indomethacin plus prophylactic pancreatic stent placement for preventing PEP in high-risk patients.8 Using the SVI trial dataset, the primary aim of this study was to compare rates of PEP and all serious adverse events between ERCPs with or without trainee involvement.