AbstractObjectivesPostoperative pancreatic fistula (POPF) is a major cause of morbidity after pancreatic surgery. Recently, endoscopic ultrasound‐guided transmural drainage (EUS‐TD) has been widely used to manage pancreatic pseudocysts after acute pancreatitis. Several studies have reported the effectiveness of EUS‐TD for POPF, although there is insufficient evidence regarding the performance of EUS‐TD for POPF. We herein report on the safety, efficacy, and appropriate timing of EUS‐TD for POPF compared with conventional percutaneous intervention.MethodsEight patients who underwent EUS‐TD of POPF and 36 patients who underwent percutaneous intervention were retrospectively enrolled. Clinical outcomes, including technical success, clinical success, and complications, were analyzed among the two groups.ResultsIn terms of clinical outcomes between the EUS‐TD and percutaneous intervention groups, significant differences were observed in the number of interventions (1 vs. 4,p= 0.011), period of clinical success (6 days vs. 11 days,p= 0.001), incidence of complications (0 vs. 3,p= 0.021), postoperative hospital stays (27 days vs. 34 days,p= 0.027), and recurrence of POPF (0 vs. 5,p= 0.001).ConclusionsEUS‐TD for POPF appears to be safe and technically feasible. This approach should be considered a therapeutic option in patients with POPF after pancreatic surgery.