Background: PPy has been criticized as a potentially unsafe procedure with an unacceptably high complication rate (24.3% in one series). Post-ERCP pancreatitis is a particular risk when PPy is performed for suspected sphincter of Oddi dysfunction (SOD)(35.5% vs. 11.3%). Hypothesis: In experienced hands, PPy should have a high success rate with acceptably few complications. Methods: Computer records of patients (pts) having ERCP at our center between 6/93 and 1/99 were retrospectively reviewed. Pure PPy cases were distinguished from those in which PPy was followed by standard sphincterotomy (SS). Data were recorded on indications and outcomes. SOD was since cannulation for manometry was not possible. As minor papillotomy, precutting on a stent in p divisum, is not a true precut, these patients were excluded. Results: 324 PPys were performed during 6816 ERCPs (4.8%). Of the 324 PPys, 168 cases of PPy alone (52%) and 156 cases combining PPy+SS (48%) were identified. Major indications for PPy alone included pancreatitis (27.4%), CBD stones (20.2%), and pancreatic CA (12.5%). Major indications for PPy + SS were pancreatitis (16%), CBD stones (37.8%), and presumed SOD (17.3%). 15 pts had a failed PPy (8.9%), but once PPy was achieved no pt failed subsequent SS. 13 pts in the PPy group (7.7%) and 7 pts in the PPy+SS group (4.5%) had a complication, for an overall PPy related complication rate of 6.2%. Table 1 shows individual complication rates. The incidence of pancreatitis in patients with presumed SOD was 1.2%. Conclusion: In experienced hands, PPy – alone, or in combination with SS, can have a low complication rate, comparable to diagnostic and therapeutic ERCP in other settings. In this series, presumed SOD was not a risk factor for PPy-associated pancreatitis.