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Results: The rate of technical success of the drainage was higher for EUD (94%, 29/31) than for CTD (72%, 21/29; P= 0.039) in intention-to-treat analysis. In cases where CTD failed (n= 8), because the pseudocysts were nonbulging, a crossover was made to EUD, which was successfully performed in all these patients. Complications occurred in 7% of the EUD and 10% of the CTD group (P= 0.67). During short-term follow-up, pseudocyst resolution was achieved in 97%(28/29) in the EUD group and in 91%(19/21) in the CTD group (P= 0.565). Long-term results analyzed on a per-protocol basis showed no significant difference in clinical outcomes between EUD (89%, 33/37) and CTD (86%, 18/21, P= 0.696).

Conclusions: We found that EUD and CTD can both be considered first-line methods of endoscopic transmural drainage of bulging pseudocysts, whereas EUD should be preferred for nonbulging pseudocysts.