INTRODUCTION: We have described a safe technique of pull-type endoscopic pancreatic sphincterotomy (EPS) with overnight nasopancreatic drainage to lower the risk of post procedural pancreatitis, (Gastrointest Endosc 1998;47:240-9). This avoids the need for pancreatic duct stenting which requires x-ray follow-up, frequent repeat endoscopy for removal, and possible pancreatic ductal injury which may not be completely reversible. The technique differs from nasobiliary drainage in significant ways. PATIENTS & METHODS: From 1/91-10/99, 238 patients underwent EPS using the following technique: After pancreatic duct cannulation, a small guide wire was advanced out to the tail followed by a monofilament pulltype EPS. Biliary ES was performed either prior to EPS or occasionally immediately after. A 5Fr nasopancreatic drain (Wilson-Cook, Winston- Salem, NC) was maneuvered out to the area of the mid-PD. The end was brought out through the right nares using a nasal transfer tube. Benzoin was applied to the lip and face and the 5Fr catheter was trimmed to 25cm from the nares. Adhesive (Tegaderm, 3M Health Care, St. Paul, MN) is placed over the entire length of the catheter from the nose to the lateral aspect of the neck. The Tuohy-Borst adapter was secured to the drainage tubing and pinned to the patient's hospital robe. Drainage was then placed to a urinary bag and kept below the level of the patient to insure gentle siphonage. RESULTS: There were 11/238 (4%) complications of EPS including mild pancreatitis (n=8), moderate bleeding (n=1), mild perforation (n=1). There was 1 instance of premature nasopancreatic drain removal by a patient and no recognized incidence of accidental internal dislodgment of the transpapillary catheter. The nasopancreatic drains were left in place for 20-72 hours (mean=24 hours). All drains could be pulled comfortably at the bedside without sedation or excessive patient discomfort. There were no complications attributed to obstruction or perforation by the catheters. IMPRESSION: Nasopancreatic drainage is a simple and quickly performed procedure which provides adequate drainage following pancreatic sphincterotomy and obviates the need for stent placement. Careful attention to details such as avoiding over-insertion of the catheter and taping it securely to the patient's face optimizes drainage and prevents premature withdrawal. Concern regarding frequent dislodgment, poor patient tolerance, and patient discomfort during withdrawal are unfounded.