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Background: Many centers advocate the use of EUS to perform transgastric drainage of peripancreatic fluid collections (PFCs). However most endoscopists do not perform EUS. We report our experience using interventional radiology (IR) placed transgastric drains as a first stage to a subsequent endoscopic transgastric PFC drainage.OBJECTIVE: To evaluate the technical and treatment success and safety profile of IR assisted endoscopic transgastric PFC drainage.PATIENTS: This study involved 11 consecutive patients referred for endoscopic drainage of PFCs over a 2-year period. INTERVENTIONS: The first stage is performed by IR under CT guidance. A suitable window to the PFC through the stomach is determined. An 18-gauge trochar needle is then advanced through the anterior and posterior wall of the stomach into the PFC. Following removal of the inner stylet, a stiff Amplatz wire is advanced. The tract is dilated and over the wire, an 8.5 F multipurpose cathether is positioned in the PFC. The second stage is performed under endoscopic and fluoroscopic guidance. The drain is removed. The posterior gastrotomy is cannulated using a wire guided sphincterotome. The tract is dilated to 15mm using an endoscopic dilating balloon. Two 10F x 5cm double pigtail stents are left across the posterior gastrostomy. The anterior gastrostomy is closed with endoscopic clips. RESULTS: 11 patients (6 males and 5 females) with mean age of 61 (range 38- 79 years) underwent IR assisted endoscopic transgastric PFC drainage (7 pseudocyst, 4 abscess) over a 2-year period. The PFCs were gallstone related in 7 patients, post surgical in 2 patients and idiopathic in 2 patients. The mean size of the PFCs was 12 cm (range 6-19 cm) in its largest dimension. The procedures were technically successful in all 11 patients. There were 3 complications (pneumothorax that was treated with a chest tube, uncomplicated pneumoperitoneum that was confirmed by diagnostic laparoscopy, delayed bleeding from posterior gastrostomy requiring endoscopic hemostasis). All patients had a successful resolution of their PFCs on follow-up imaging. The median length of hospital stay was 11.5 days (range 1-86 days). At a mean follow-up period of 14 months (range 2-29 months), all patients were doing well.CONCLUSIONS: IR assisted endoscopic transgastric PFC drainage is technically feasible and safe and is associated with favourable clinical outcomes.