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Background: Endoscopic transpapillary drainage is usually not advocated for large pseudocysts especially at tail end of pancreas for fear of infection. We attempted transpapillary drainage with nasopancreatic drain (NPD) or stent alone in large pseudocysts (>6 cm) located at tail end of pancreas. Methods: Over a period of three years, 11 patients (9 male) with large pseudocysts located at tail end of pancreas were treated with attempted transpapillary drainage. An informed consent was obtained, intravenous midazolam and hyoscine butyl bromide were administered and endoscopic retrograde pancreatography (ERP) was performed. Initially, an attempt was made for a contrast free deep pancreatic duct cannulation. When it was not possible minimal contrast was injected. On endoscopic retrograde pancreatography (ERP), a 5F or 7 Fr stent or nasopancreatic drain (NPD) was placed across / near the site duct disruption. The end points of treatment were resolution of pseudocyst or need for surgery. Results: Nine patients had an underlying chronic pancreatitis (alcohol 5 and idiopathic 4) and two patients had pseudocyst as sequelae of acute pancreatitis (drug induced 1 and idiopathic 1). The size of pseudocysts ranged from 7 to 15 cms (mean: 9.8+3.1 cms). Nine patients had partial duct disruption and 2 patients had complete disruption. An attempt to place NPD was made in 5 patients and a stent in 6 patients. In the NPD group, deep cannulation could not be achieved in 1 patient with complete disruption; he was treated successfully with antibiotics and percutaneous drainage. In other 4 patients with partial duct disruption, NPD was successfully placed bridging the disruption and all these patients had resolution of pseudocyst within 6 weeks. The NPD got blocked in one patient at day 14 and was successfully opened by flushing. In the stent group, 5 had partial and 1 had complete duct disruption. The patient with complete disruption and non-bridging stent had successful outcome at 8 weeks. Out of 5 patients with partial disruption, one recovered uneventfully at 6 weeks with a stent bridging the disruption. The other 4 patients (bridging stent in 3) developed febrile illness and infection of the pseudocyst. They required additional percutaneous drainage and antibiotics for successful resolution. There was no recurrence of the pseudocysts in a mean follow up of 16.4 months. Conclusion: Endoscopic transpapillary drainage with a NPD bridging the disruption is associated with good outcome even in patients with large pseudocysts at the tail end of pancreas. However, there was increased frequency of infection when a stent was used for drainage.