A single therapeutic echo endoscope used for combined transgastric and transpapillary drainage of a pancreatic abscess.

The design of endoscopic ultrasound (EUS) instruments has been improved to provide a wide therapeutic channel and an elevator to facilitate the movement of needles and medical devices. These im− provements make it possible to carry out combined ultrasound and endoscopic ap− proaches in the pancreas and duodenal papilla, with ultrasound examination of surrounding fluid collections [1± 5]. Cys− togastrostomy is a particularly interesting field for therapeutic endosonography, with major advantages over conventional therapeutic endoscopy ± including in− creased safety, access to distant collec− tions, and differentiation of cystic lesions [5]. Although cystoenterostomy is an effective form of treatment, it does not provide treatment for impaired ductal drainage [3]. We report here on the use of a combined EUS and endoscopic retro− grade cholangiopancreatography proce− dure using a single echo endoscope.