Postoperative pancreatic fistula (POPF) is one of the most prevalent clinically relevant complications following partial pancreatic resection. Endoscopic approaches have proven successful, but the literature regarding the best route of drainage is scarce. Our study was aimed at comparing the efficacy and safety of transpapillary (endoscopic retrograde cholangiopancreatography [ERCP]-based) and transmural (endoscopic ultrasound [EUS]-guided) endoscopic treatment of POPF occurring after distal pancreatectomy.