A 42-year-old male consulted us because of hiccups on eating, which was revealed to be caused by an esophageal cyst. Though it is confirmed to be one of congenital diseases, such matters of importance as clinical classification and indication for operation still remain controversial. The therapeutic procedure we made was endoscopic ultrasonogram (EUS) -guided needle aspiration. The echoendoscope, Pentax FG32-UA, is a forward oblique-scanning fiberoptic scope with a convex type array ultrasonic transducer. The needle inserted through the instrumentation channel can be visualized both endoscopically and ultrasonically. This new method enabled us to puncture the esophageal cyst with accuracy and safety, and the lesion apparently decreased in size. In general, cystic lesions of gastrointestinal tract may be treated the best by EUS-guided needle aspiration. It is certain that the modality will play a more important role in both diagnosis and treatment in the near future.