Interventional endoscopic ultrasonography (EUS) including EUS-guided fine needle aspiration (FNA), biliary drainage (BD), and pseudocyst drainage (PD) has recently been widely performed.1 However, if stenosis of the esophagus is present, it may be challenging to perform EUS-FNA or EUS-PD because the stomach becomes inaccessible. Recently, a forward-viewing echoendoscope (FV, GF-UCT140-AL5; Olympus Optical Co, Ltd, Tokyo, Japan) has become available.2,3 Technical tips of EUS-PD in a patient complicated with esophageal stenosis using a FV-EUS combined with balloon assist technique and novel EUS-PD technique are described.