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In a significant proportion (291%, or n=32) of the cases, endoscopy-guided, peri-anastomotic pigtail stents for internal drainage were implemented as either a primary, secondary, or tertiary treatment approach. Employing a decision-algorithm, we observed a superior primary success rate (778% versus 537%) and secondary success rate (857% versus 684%) in patients treated endoscopically compared to percutaneously, alongside