Aim: Identify predictors of outcome in pancreatic duct (PD) disruption managed by endoscopic trans-papillary stenting. Methods: Patients were identified from the endoscopy database. Disruption was defined by extravasation of contrast from the PD during ERCP. Data collected included patients demographics, imaging studies, management before and outcomes after pancreatic stenting. Stents were typically exchanged at intervals of 6-8 weeks. Success was defined as resolution of PD disruption clinically and at repeat ERCP. Results: Ninety-seven consecutive patients were studied from 1995-2002: 34 female; mean age 53.7 yrs (SD=12.3 yrs). Etiology of PD disruption included acute pancreatitis (44), chronic pancreatitis (46), operative injury (4), and trauma (3). Trans-papillary PD stenting was technically successful in 92 (95%) patients; 2 underwent a combined cyst-enterostomy. Disruption was noted in the pancreatic head in 15 (16%), genu 30 (33%), body 18 (20%), tail 19 (21%) and multiple sites in 10 (10%) patients. The mean duration of stent therapy was 90.4 days (SD=135.6 days). Stenting was successful (resolution of PD disruption both clinically and at repeat ERCP) in 52 patients (55%), unsuccessful in 32 (36%) and the outcome indeterminate in 8 (9%). Long-term resolution of PD disruption was achieved in 49 of the 52 (94%) stented patients; 2 with recurrent disruption were treated successfully by restenting and 1 lost to follow-up. On univariate analysis, placement of a stent across the site of disruption (p < 0.001) and disruption at body of the pancreas (p=0.02) were associated with a successful outcome. On multivariate analysis, only the placement of a bridging stent across the disruption correlated with outcome. The need for repeated stent exchanges was associated with diminished success rates: 1, 67%; 2, 25%; 3 or more, 4%. Thirty-one of 32 patients treated unsuccessfully by endoscopic stenting underwent surgical/radiological interventions; 1 was lost for follow-up. Complications occurred in 6 patients. Conclusion: Placement of a bridging stent at endoscopy predicts successful outcome in pancreatic duct disruption. When resolution of duct disruption does not occur within one to two sessions of stent exchange, alternate therapy should be considered.