Background/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an effective diagnostic technique; however, few studies have evaluated the efficacy of trans-colorectal EUS-FNA. This study assessed the feasibility of trans-colorectal EUS-FNA.Methods: We retrospectively analyzed 76 consecutive patients who underwent trans-colorectal EUS-FNA for pelvic lesions between January 2013 and September 2023.Results: A total of 76 pelvic lesions were identified. The median number of EUS-FNA punctures was 3 (1–8). The median lesion size was 18.9 (8.2–100.0) mm. The success rate was 98.7% (75/76), with no reported adverse events. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS-FNA were 94.3% (50/53), 100% (22/22), 100% (50/50), 88.0% (22/25), and 96.0% (72/75), respectively. Malignancy was initially suspected in 65 patients before EUS-FNA; however, 25 patients showed benign results. Of these, three were later reexamined and diagnosed with malignancy, three underwent surgery and were found to have benign pathology, and 19 avoided unnecessary surgery.Conclusions: Trans-colorectal EUS-FNA is a safe and effective diagnostic procedure.

Background/Objectives: Endoscopic ultrasound-guided pancreatic duct drainage (EUS-guided PDD) has emerged as an important technique for managing pancreaticojejunostomy anastomotic strictures (PJAS) following pancreatoduodenectomy. However, long-term outcome data remain limited. This study aimed to evaluate the long-term outcomes of EUS-guided PDD for benign PJAS. Methods: This single-center retrospective cohort study included 46 patients who underwent technically successful EUS-guided PDD for benign PJAS between May 2011 and June 2025. The primary outcome was cumulative clinical fistula patency assessed by Kaplan–Meier analysis. Secondary outcomes included adverse events and risk factors for re-intervention. Results: Technical success was 95.83% (46/48), with clinical success in all technically successful cases. Cumulative clinical fistula patency rates were 82.20% at 1 year and 75.90% at 3 and 5 years. Postprocedural adverse events occurred in 28.26%. Unplanned re-intervention was required in 19.57%, exclusively among patients symptomatic before the initial procedure; symptomatic-status effects were therefore non-estimable. No independent predictors of unplanned re-intervention were detected, and no differences were observed between EUS-guided pancreaticogastrostomy (EUS-guided PGS) and EUS-guided pancreatojejunostomy (EUS-guided PJS). Conclusions: EUS-guided PDD achieved high technical and clinical success with durable long-term patency (82.20% at 1 year; 75.90% at 3 and 5 years). Differences between EUS-guided PGS and EUS-guided PJS and independent predictors of unplanned re-intervention were not detected; because all nine re-interventions occurred in patients symptomatic at baseline and none in asymptomatic patients, symptomatic-status effects were non-estimable.