Single-step EUS-guided drainage of a pancreatic pseudocyst with a modified guidewire as a cystotome

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 catheter 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...