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Introduction Fully covered self-expandable metal stents (fcSEMS) are commonly used to manage both benign and malignant biliary strictures in ERCP. Although fcSEMS are known to increase the risk of post-ERCP pancreatitis (PEP) the degree to which they increase this risk remains poorly defined. We performed a large retrospective analysis of fcSEMS placement at ERCP across two centers to provide real-world data on the magnitude by which fcSEMS placement increases PEP risk, aiming to adjust for other common variables known to influence PEP.Methods 883 ERCP procedures were reviewed by two authors across two sites: Royal United Hospitals Bath (483 procedures, performed between 1.1.24 – 31.12.25) and North Bristol NHS Trust (400 procedures, performed between 1.1.19 – 31.10.23). Data was collected on fcSEMS placement and incidence of PEP as well as variables including patient age, pancreatic duct cannulation, use of pre-cut, dual wire technique, NSAID use and placement of pancreatic stents. Where data allowed, multivariable logistic regression was performed to adjust for the impact of other variables on fcSEMS PEP risk.Results There were 103 cases of fcSEMS placement in the 883 procedures reviewed. Among patients who had a fcSEMS placed there was a 11.7% PEP rate (12/103) vs. a 2.43% PEP rate (19/780) among all other patients (p <0.001, OR 5.29 (95% CI 2.49 – 11.25)). Multivariable logistic regression was performed to adjust for PD cannulation, use of dual wire technique and pre-cut sphincterotomy ( table 1), with fcSEMS placement remaining strongly associated with PEP after adjustment for these variables (aOR 5.54, 95% CI 2.55 – 12.04, p<0.001). Due to inconsistent data, we could not adjust for prophylactic NSAID use or pancreatic stent placement, although almost all patients received prophylactic NSAIDs routinely.Conclusions Our results demonstrate a PEP rate of 11.7% following fcSEMS placement. After adjustment for three variables known to increase PEP risk fcSEMS placement increased the risk of PEP over five times (aOR 5.54) compared with plastic, uncovered or no stent placement; a higher risk than that demonstrated in similar studies. 1 Our findings highlight the importance of high clinical vigilance and careful decision making when considering fcSEMS use and adopting enhanced prophylactic measures (including a low threshold for pancreatic stent placement) in these situations.Reference Radetic M, et al. Risk of post-endoscopic retrograde cholangiopancreatography pancreatitis due to placement of biliary self-expandable metal stents: a single center retrospective study. Gastrointestinal Endoscopy 2025;102(5):682–689.Abstract P14 Table 1PredictorAdjusted OR (95% CI)p-valuefcSEMS placement5.54 (2.55 – 12.04)<0.001PD cannulation2.83 (1.23 – 6.50)0.014Pre-cut sphincterotomy1.63 (0.69 – 3.85)0.263Dual-wire technique2.38 (0.74 – 7.66)0.146