In EUS-guided drainage of pancreatic pseudocysts (PPCs), the cystogastrostomy tract is usually established using a cystotome with a guidewire, and a stent or nasocystic cath- eter is implanted. However, cystic fluid leakage could occur before implantation. Therefore, we modified a guidewire (Fusion LoopTip, Cook Medical, Bloomington, Ind, USA) with a loop tip as a cystotome (Fig. 1A) by shearing its terminal coating, bending it, and plugging it into an electrosurgical unit (VIO 200 S, Erbe, Tübingen, Germany) (Fig. 1B). The loop tip was sleeved onto the inserted guidewire, and a nasocystic catheter was inserted next to the loop tip (Fig. 1C). Thus, the cystogastrostomy tract was established, and the nasocystic catheter was implanted simultaneously. This new 1-step EUS-guided drainage is easier to perform and reduces the risk of leakage.
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