Endoscopic-guided pancreatic pseudocyst drainage has been reported to be an effective means for alleviating symptoms related to pancreatic fluid collections.1-3 Several investigators have suggested that performance of the procedure with EUS guidance may allow drainage of pseudocysts that cannot be drained with a purely endoscopic method because of the absence of an intraluminal bulge or the presence of adjacent vascular structures that preclude safe entry.4-7 In both of these circumstances, EUS guidance of the drainage procedure may theoretically reduce the risk for perforation and/or bleeding. Previously, EUS-guided pancreatic pseudocyst drainage was limited by the lack of echoendoscopes with elevators and/or sufficiently large accessory channels to allow passage of a large-caliber endoprosthesis (10F or greater in size). This report describes the technical features and operating characteristics of a recently introduced large-channel linear scanning echoendoscope with an elevator (XGF-UCT30, Olympus America, Inc., Melville, N.Y., Fig. 1) when used for pseudocyst drainage. CASE REPORT A 46-year-old man with alcohol-induced chronic pancreatitis complicated by partial gastric outlet obstruction and biliary obstruction was referred for endoscopic drainage of a 6.5 cm pseudocyst posterior to the antrum and duodenum. Institutional Review Board approval as required under Minnesota law was obtained for review of the medical record. Initial contrast CT of the abdomen demonstrated peripancreatic inflammatory changes, pancreatic calcification, and biliary dilation. The patient was treated with an endoscopically placed venting gastrotomy, endoscopic biliary stent placement, and nutritional support while abstaining from alcohol ingestion. The gastric outlet obstruction resolved but he required interval stent changes over the ensuing 12 months because of clogging and persistence of the biliary stricture. Enteral intake was resumed and the gastrostomy tube was removed. Follow-up over this interval with CT imaging demonstrated conversion of the inflammatory changes in the head region of the pancreas into a 6.5 cm