Background and Study Aims: Portal hypertension often coexists with pancreatic pseudocysts and is potentially dangerous if a collateral vessel is in the vicini ty of the needle puncture pathway. Hitherto, there have been no reports of pseud ocyst drainage in this setting. Patients and Methods: Patients who underwent end oscopic ultrasound (EUS)-guided pancreatic pseudocyst drainage complicated by i ntervening vessels were assessed for success and outcomes. An Olympus mechanical linear-array video echo endoscope GF-UM 140D was used for the drainage proced ure in all patients. Either a “hot“diathermy technique was employed or a “cold ” technique using direct aspiration with a 19-G needle, followed by deployment of a nasocystic catheter. Results: Eight patients with a symptomatic pseudocyst and intervening vessels underwent drainage that was guided (n = 6) or assisted ( n = 2) by EUS. All were found to have successful resolution of the cyst at follo w-up 6 weeks later, while segmental portal hypertension had disappeared in one patient. There were no major complications.One patient had transient hemorrhagic drainage that resolved by itself. Conclusions: Pseudocysts complicated by porta l hypertension or by intervening vessels can be safely drained under EUS guidanc e, even in the absence of color Doppler imaging. Background and Study Aims: Portal hypertension often coexists with pancreatic pseudocysts and is potentially dangerous if a collateral vessel is in the vicini ty of the needle puncture pathway. Hitherto, there have been no reports of pseud ocyst drainage in this setting. Patients and Methods: Patients who underwent end oscopic ultrasound (EUS) -guided pancreatic pseudocyst drainage complicated by i ntervening vessels were assessed for success and outcomes. An Olympus mechanical linear-array video echo endoscope GF-UM 140D was used for the drainage proced ure in all patients. Either a “hot ” diathermy technique was employed or a “cold ” technique using direct aspiration with a 19-G needle, followed by deployment of a nasocystic catheter. Results: Eight patients with a symptomatic pseudocyst and intervening vessels underwent drainage that was guided (n = 6) or assisted (n = 2) by EUS. All were found to have successful resolution of the cyst at follo w-up 6 weeks later, while segmenta l portal hypertension had disappeared in one patient. There were no major complications. One patient had transient hemorrhagic drainage that resolved by itself. Conclusions: Pseudocysts complicated by porta l hypertension or by intervening vessels can be safely drained under EUS guidanc e, even in the absence of color Doppler imaging.