Endoscopic ultrasound (EUS)-guided cystogastrostomy is a key minimally invasive approach for treating pancreatic fluid collections (PFCs), offering high success rates with lower morbidity than surgery. While lumen-apposing metal stents (LAMS) have become widely used—particularly for walled-off necrosis—double pigtail plastic stents (DPPS) remain a safe, cost-effective option, especially for uncomplicated pseudocysts requiring simple drainage. Despite their broad use, real-world outcome data on DPPS remain variable, and evidence from Central and Eastern Europe is limited. 

This study aimed to assess the real-world performance of EUS-guided cystogastrostomy using DPPS over a nearly three-year period at a high-volume tertiary pancreatic center.

We conducted a retrospective review of all EUS-guided cystogastrostomy procedures performed with DPPS at our institution between November 2022 and July 2025. Data were collected from electronic medical records and endoscopy reports, including patient demographics, indications, cyst characteristics, procedural steps, stent size and number, and peri-procedural details. Technical success, clinical outcomes, and procedure-related adverse events were assessed according to standard definitions. All variables were analyzed using descriptive statistics.

A total of 50 EUS-guided cystogastrostomy procedures were performed during the study period. Most interventions (48/50) targeted pancreatic fluid collections, while 2 were performed for duodenal collections. The cohort included 58% male patients with a mean age of 56 years. The mean procedure time was 33 minutes. Cyst puncture was performed using a 19G fine-needle aspiration needle, followed by tract dilation with either an 8.5 Fr or 10 Fr cystotome. DPPS (8.5–10 Fr, 2–10 cm) were placed in all cases; two stents were inserted in 6 procedures. Cyst size data were available for 32 patients, the majority of whom had collections measuring >6 cm.

Technical success was achieved in 48 of 50 cases (96%). Clinical improvement was observed in most successfully treated patients during follow-up. Four procedure-related adverse events occurred: one perforation requiring urgent surgical management and three bleeding events, all of which were managed endoscopically without further intervention.

EUS-guided cystogastrostomy with DPPS proved to be feasible and effective, with high technical success and an acceptable safety profile. While LAMS may be beneficial in more complex cases, our results support DPPS as a cost-effective and reliable option for uncomplicated PFCs.