Background Endoscopic ultrasonography (EUS) guided transmural drainage has become a first-line treatment for peripancreatic fluid collections (PFCs). Postoperative bleeding may lead to severe clinical outcomes. The purpose of this study was to explore the patient-related and surgery-related factors associated with postoperative bleeding.

Methods This is an observational cohort study. A total of 181 patients who underwent EUS drainage at our center between June 2019 and May 2023 were enrolled and analyzed in the study. Postoperative bleeding complications were observed, and patient and operation-related data were collected. Univariate and multifactorial logistics regression was performed to determine the risk factors that may affect postoperative bleeding. Determine the risk factors affecting postoperative bleeding.

Results We achieved a 100% technical success rate. A total of 14 cases (7.7%) of bleeding occurred. All bleeding patients were successfully treated using conservative, endoscopic, interventional, and other treatments. Logistic regression analysis showed that cyst size was an independent risk factor for bleeding after EUS-guided transmural drainage (P=0.006; OR,2.722; 95%CI,1.327-5.587).

Conclusions The cyst size was an independent risk factor for bleeding after PFC drainage. Slowing the rate of decline in intracystic pressure may reduce the risk of bleeding.