Objective: Our study aims to investigate the effectiveness of transmural drainage, transpapillary drainage and their combination in reducing cyst recurrence rates in patients with DPDS. Methods: We conducted a retrospective study involving 22 patients diagnosed with DPDS through ERCP, MRCP, and CT scan. Patient data including clinical information, imaging characteristics, drainage technique, complications, and outcomes were collected from the medical records and telephone follow-ups. Results: In our study, we treated recurrent cysts as new and independent cases. 27 endoscopic treatments were categorized into three groups based on the procedural approach: transmural in 11 cases, transpapillary in 8, and a combination of both in 8. The combined drainage group exhibited a significantly higher drainage success rate compared to the transpapillary group (100% vs. 50%, P=0.012), with no significant difference compared to the transmural group (90.9%, P=0.621). The one-year recurrence rate was significantly lower in the combined drainage group than in the transmural drainage group (0% and 55.6%, respectively, P=0.018) and was lower than in the transmural drainage group (42.9%, P=0.085), but did not reach significance. No significant differences were observed in technical success rate, treatment success rate, or complication rate. Conclusion: Transmural drainage of cysts combined with pancreatic duct stent placement results in satisfactory drainage of cystic fluid in the short term and significantly reduces one-year recurrence in patients with DPDS.