Situations requiring both endoscopic ultrasound (EUS)– and endoscopic retrograde cholangiopancreatography (ERCP)–related procedures are common in patients with biliopancreatic diseases. To minimize patient burden and hospital stay, these procedures are often performed sequentially in a single session, necessitating scope exchange between an echoendoscope and a duodenoscope. However, scope exchange increases procedure time, patient discomfort, infection risk, and reprocessing costs. Although Rocca et al. reported common bile duct stone cases underwent simultaneous EUS observation and ERCP using a radial echoduodenoscope¹⁾, no reports have described performing both EUS– and ERCP–related procedures with a single echoendoscope. De Angelis et al. developed a convex echoendoscope enabling such combined procedures, but it never reached commercialization due to issues related to multidrug-resistant organisms²⁾.

The recently released oblique viewing convex echoendoscope (EG-740UT; Fujifilm, Tokyo, Japan) offers improved flexibility, wider angulation, an increased elevator angle, wider diameter of accessory channel, and an expanded optical field of view compared with conventional echoendoscopes. In addition, because the channel outlet exits on the distal and lower side of the optical lens, catheters can be more easily directed along the axis of the bile duct. These features enable the performance of ERCP. We report a retrospective study including consecutive patients underwent simultaneous EUS– and ERCP–related procedures using EG-740UT between August 2024 and November 2025.

A total 17 patients (median 74 y/o [IQR:62-81]; 53% male; 76% native papilla) underwent combined EUS– and ERCP–related procedures for following indications: suspected malignant biliary obstruction (n = 13), suspected autoimmune pancreatitis with biliary stricture (n = 2), gallstone-related cholangitis with liver abscess (n = 1), and suspected choledocholithiasis (n = 1). EUS–related procedures included tissue acquisition (n = 12), hepaticogastrostomy (n = 3), abscess drainage (n = 1), and observation (n = 2). All ERCP–related procedures were performed for biliary indications. Biliary cannulation was successful in 14 (82%) patients in median 8 minutes (IQR: 6-14.5). ERCP–related procedures in successful cases included sphincterotomy (n = 11), plastic stent placement (n = 9), metal stent placement (n = 5), brush cytology (n = 2), and forceps biopsy (n = 1, with median procedural time 28 minutes (IQR: 21.75-37). In the three cases of failed biliary cannulation, duodenoscope exchange led to successful cannulation in two cases, whereas one case required conversion to hepaticogastrostomy due to duodenal invasion. Adverse events developed in two patients (one case each of pancreatitis and cholecystitis), but none were considered specific to this combined procedure. 

Combined EUS– and ERCP–related procedures using EG-740UT was feasible. It may reduce procedure time, patient discomfort, infection risk, and reprocessing costs. Furthermore, in cases where ERCP is absolutely impossible—such as those with duodenal invasion—the procedure can be converted to a transluminal drainage approach without the need to change the endoscope, which represents an additional advantage. Further prospective studies are warranted.