The cannulation technique was 205 (82%) direct cannulation with wire and sphincterotome, 38 (15%) two-wire technique and 7 (3%) needle knife. Of the 38 patients with biliary cannulation via a two-wire technique, 28 had temporary pancreatic duct stents placed as prophylaxis against post-ERCP pancreatitis. All patients had pre-procedure prophylactic antibiotics to prevent cholangitis and 81 (23%) had 100 mg rectal indomethacin suppository. Adriamycin solubility dmso The overall complication rate was very low, occurring in 2 (0.6%) patients. There was 1 case of mild pancreatitis (0.4% rate of PEP for naïve papilla)

and 1 post sphincterotomy bleed which required repeat duodenoscopy where hemostasis was achieved. There were no perforations. Conclusion: The use of pre-operative imaging to facilitate appropriate case selection, modern cannulation technique and prophylactic measures to prevent PEP where required (including pancreatic duct stenting and rectal indomethacin) enabled a newly-qualified endoscopist to achieve high biliary cannulation rates (97%) and a very low rate of adverse events (0.6%). Utilizing this approach, ERCP is a safe and effective

procedure. K SUBRAMANIAM,1 K SPILSBURY,2 OT AYONRINDE,3,4,5 GSK3 inhibitor F LATCHMIAH,3 A MUKHTAR,2 J SEMMENS,2 MF LEAHY,6 JK OLYNYK3,4,7,8 1Gastroenterology and Hepatology Unit, The Canberra Hospital, Canberra, ACT, Australia, 2Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia, 3Department of Gastroenterology, Fremantle Hospital, Fremantle, WA, Australia, 4Faculty of Health Sciences, Curtin University, tuclazepam Bentley, WA, Australia, 5School of Medicine and Pharmacology (Fremantle Hospital Campus), The University of Western Australia, WA, Australia, 6Department of Haematology, Fremantle Hospital, Fremantle, WA, Australia, 7Department

of Gastroenterology, Fiona Stanley Hospital, Perth, WA, Australia, 8Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, WA, Australia Background: Acute upper gastrointestinal bleeding (UGIB) is a common medical emergency resulting in significant morbidity, mortality and cost of care. Gastrointestinal bleeding (mostly UGIB), is the second most common indication for red blood cell (RBC) transfusion in Western Australia, accounting for 21% of all RBCs used. Whilst RBC transfusion may be life-saving in massive UGIB, recent controlled trials suggest that a liberal transfusion practice is associated with increased re-bleeding rates and reduced survival after UGIB.1 However, little is known about the outcome of RBC transfusion after UGIB in Australian patients managed outside of strict clinical trial conditions. We hypothesized that patients who receive RBC transfusion after acute UGIB, have increased mortality compared with those patients who do not receive RBC transfusion after adjusting for the severity of the bleeding episode and underlying comorbidities.