Background: Peripancreatic fluid collections (PFCs) are a common complication after distal pancreatectomy and are usually managed by percutaneous drainage. The role of EUS in the management of postoperative PFCs has not been previously reported. Objective: To evaluate the role of EUS in the management of PFCs after distal pancreatectomy. Study Design: Case series. Setting: Academic tertiary referral center. Patients: Symptomatic patients with PFCs after a distal pancreatectomy. Interventions: At EUS, the PFCs were accessed transgastrically by using a 19-gauge FNA needle and after passage of a 0.035-inch guidewire; sequential dilation of the transgastric tract was performed up to 8 mm and multiple 7F or 10F double-pigtail stents were deployed. Nasocystic drainage catheters were deployed in those with poor drainage at the time of endoscopy. Main Outcome Measurements: To evaluate the technical and treatment success and safety profile of the EUS-based approach for management of PFCs after distal pancreatectomy. Results: Ten patients (6 men, 4 women; mean age, 56.8 years [range 20-76 years]) underwent EUS-guided drainage of PFCs after distal pancreatectomy over a 30-month period. Indications for distal pancreatectomy were neuroendocrine tumor in 5 patients, focal chronic pancreatitis in 2, cyst neoplasm in 1, adenocarcinoma in 1, and trauma in 1. The mean size of the PFCs (largest dimension) was 91.4 mm (range 45-140 mm). EUS-guided drainage was technically successful in all 10 patients; 1 patient underwent EUS-guided drainage of 2 large noncommunicating PFCs in the same endoscopy session. Treatment was successful in 9 (90%) of 10 patients; 1 patient had persistent symptoms requiring reoperation. No procedural complications were encountered. At a mean follow-up of 151 days (range 96-280 days), all 9 patients were doing well without any evidence of symptom recurrence. Limitations: Small number of patients and lack of a comparative treatment group. Conclusions: EUS-guided drainage is a minimally invasive, safe, and highly effective technique for the management of symptomatic PFC after distal pancreatectomy. © 2009.