Endoscopic pancreatic duct drainage has been by transpapillary or trans-anastomotic approach, and more recently by transluminal approach. In a transpapillary approach, a pancreatic stent or nasopancreatic drainage tube is inserted through the papilla after pancreatography and guidewire insertion to the pancreatic duct using duodenoscope or balloon-assisted enteroscope. Transpapillary/anastomotic pancreatic drainage is employed frequently for impaired pancreatic drainage such as chronic pancreatitis. In addition, the preventive effect of pancreatic stents for patients with post-ERCP pancreatitis has been widely accepted. Transluminal pancreatic drainage has been regarded as an alternative approach for transpapillary drainage. A plastic stent is inserted through the gastric wall to the pancreatic duct after puncture of the pancreatic duct under endoscopic ultrasound (EUS), guidewire insertion to the pancreatic duct, and dilatation of the puncture site. A transpapillary or trans-anastomotic approach should consider a rendezvous technique in cases of difficult dilatation of the puncture site. However, given technical success and high complication rates, transluminal pancreatic drainage should be limited to endoscopists proficient in EUS-related procedures.