Long-Term Outcomes of EUS-Guided Pancreatic Duct Drainage for the Management of Benign Pancreaticojejunostomy Anastomotic Stricture—A Retrospective Cohort Study

<b>Background/Objectives:</b> Endoscopic ultrasound-guided pancreatic duct drainage (EUS-guided PDD) has emerged as an important technique for managing pancreaticojejunostomy anastomotic strictures (PJAS) following pancreatoduodenectomy. However, long-term outcome data remain limited. This study aimed to evaluate the long-term outcomes of EUS-guided PDD for benign PJAS. <b>Methods:</b> This single-center retrospective cohort study included 46 patients who underwent technically successful EUS-guided PDD for benign PJAS between May 2011 and June 2025. The primary outcome was cumulative clinical fistula patency assessed by Kaplan-Meier analysis. Secondary outcomes included adverse events and risk factors for re-intervention. <b>Results:</b> Technical success was 95.83% (46/48), with clinical success in all technically successful cases. Cumulative clinical fistula patency rates were 82.20% at 1 year and 75.90% at 3 and 5 years. Postprocedural adverse events occurred in 28.26%. Unplanned re-intervention was required in 19.57%, exclusively among patients symptomatic before the initial procedure; symptomatic-status effects were therefore non-estimable. No independent predictors of unplanned re-intervention were detected, and no differences were observed between EUS-guided pancreaticogastrostomy (EUS-guided PGS) and EUS-guided pancreatojejunostomy (EUS-guided PJS). <b>Conclusions:</b> EUS-guided PDD achieved high technical and clinical success with durable long-term patency (82.20% at 1 year; 75.90% at 3 and 5 years). Differences between EUS-guided PGS and EUS-guided PJS and independent predictors of unplanned re-intervention were not detected; because all nine re-interventions occurred in patients symptomatic at baseline and none in asymptomatic patients, symptomatic-status effects were non-estimable.