A postoperative pancreatic fistula (POPF) is a serious complication after gastrectomy. A case of a POPF after gastrectomy treated using endoscopic transgastric drainage is reported. A 67-year-old woman underwent laparoscopic-assisted distal gastrectomy. On the 4th postoperative day, she developed a high fever and back pain. A pancreatic fistula was diagnosed on computed tomography (CT). Conservative therapy was started and resulted in temporary relief of the inflammatory reaction, but her symptoms recurred repeatedly. An abdominal abscess due to a pancreatic fistula was diagnosed on CT on the 28th day after the start of conservative therapy. The patient was then considered to be a candidate for drainage. However, since there was no safe route for percutaneous puncture, endoscopic ultrasound (EUS)-guided transgastric drainage was performed. Her high temperature dropped rapidly, and CT confirmed a significant decrease in the retained fluid ; she was discharged from our hospital on the 18th postoperative day.

In cases in which conservative therapy is unsuccessful and percutaneous fine needle drainage is difficult for a POPF after gastrectomy, EUS-guided transgastric drainage may be one choice for treatment.