Background: The etiology of PEP is probably multifactorial. Pancreatic stenting has been shown to reduce the incidence of PEP in selected patients. We hypothesized that normal diameter ducts are more likely to become occluded by edema and hence associated with PEP. The relationship between the findings of pancreatic ductography and PEP is not known. Aim: Evaluate if there is an association between pancreatic duct dilatation (PDIL) and PEP. Methods: The MUSC GI Trac database was reviewed for patients who had successful pancreatography. Patients with cancer, stricture, stones and prior pancreatic duct or orifice therapy were excluded. The incidence of PEP was evaluated in patients who did or did not have (PDIL). Patients were sub-grouped if they had a pancreatic stent placed and/or concomitant biliary sphincterotomy (BSx). Results: Of 3298 patients (mean age 49yrs., range 10-89yrs., M:F= 3:7), PEP occurred in 150 (5%). A dilated duct was noted in 801 patients. The incidence of PEP in all patients with PDIL was 3% (23/801) compared to 5% (127/2497) in those with no PDIL, p=0.008. The incidence of PEP in patients with and without BSx, pancreatic stenting and PDIL, is tabulated: Of all patients who had a pancreatic stent placed (n=887), there was no statistical difference in the incidence of PEP in those with PDIL (3%, 10/316) Vs no PDIL (5%, 27/571). CONCLUSIONS: 1] The overall incidence of PEP is lower if the pancreatic duct is dilated. 2] The presence of duct dilatation in patients who do not undergo BSx or PD stenting is associated with a lower incidence of PEP.