Advanced EUS-Guided Interventions Other Than EUS-FNA Using Mechanical Linear Echoendoscope without Color Doppler Parupudi V. Sriram, Guduru V. Rao, Darisetti Santosh, Duvvuru Nageshwar Reddy Background: Mechanical linear echoendoscopes (MLE) are not generally used for EUS-guided interventions due to lack of color Doppler despite few reports on its use for cytodiagnosis. We describe our experience using MLE to perform advanced EUS-guided interventions other than cytodiagnosis. Methods: Between 4/2000 12/ 2003, 22 patients (mean age 46.7 years; 17 Males) underwent various EUS-guided interventions under conscious sedation after informed consent. All patients were initially evaluated using radial EUS. Intramural or intervening vessels in the path of the needle were recognized as tortuous, anechoic channels that could be tracked by gentle maneuvering of the MLE back and forth and sideward prior to puncture. 23G needles were used for celiac plexus block (CPB) and 19G needles or a custommade needle-catheter assembly for pseudocyst drainage (PD) or biliary access (BA). Bupivacaine and absolute alcohol or triamcinolone was used for CPB. A naso-cystic or naso-biliary catheter was deployed initially for PD or BA for subsequent conversion to endoprosthesis where applicable. All patients were monitored regarding complications. Results: The procedures performed included celiac plexus block (nZ12) for intractable pain due to advanced malignancy (pancreatic-3, biliary-2) or chronic pancreatitis (tropical-7), despite surgery and medication; drainage of complicated pseudocysts due to chronic pancreatitis [nZ7 (tropical-5; alcoholic-1, idiopathic-1)]; and EUS-guided biliary access (nZ3) following failed ERCP for malignant biliary obstruction (pancreatic-1, ampullary-2). Overall, 9 patients (all PD and one each for CPB & BA) had associated intervening collaterals (CPB-2, PD-5) or vessels (PD-2, abnormally coursing splenic artery and an unnamed vessel). All EUS-guided interventions were successful without any major complications. One patient undergoing PD developed transient bleeding, which cleared within 24 hours without any drop in hematocrit or need for transfusions. Conclusions: Advanced EUS-guided interventions other than FNA can also be safely performed using the mechanical linear echoendoscope in the absence of electronic instruments. Color Doppler function is not mandatory for performing these procedures.