Introduction <p>Endoscopic transmural drainage (ETD) using a therapeutic oblique-viewing echoendoscope is procedure of choice for symptomatic walled-off necrosis (WON). However, occasionally the procedure fails because of poor visualization, non-negotiation of proximal luminal narrowing, presence of intervening venous collaterals or difficult puncture because of oblique angle. In such situations, a forward-viewing echoendoscope (FVE) may offer technical advantages.</p> Objective <p>To evaluate safety and efficacy of EUS-guided ETD of WON using a FVE in patients in whom drainage could not be completed using oblique-viewing echoendoscope.</p> Methods <p>The endoscopic database of a tertiary-care center was retrospectively reviewed and patients who underwent ETD of WON using a FVE following failure with a conventional oblique-viewing echoendoscope were identified. Demographic data, characteristics of WON, procedural details, technical success, and procedure-related adverse events were analyzed.</p> Results <p>Twenty-one patients (18 males; age range 12–54&#xa0;years) underwent ETD using a FVE. The size of the WON ranged from 9 to 18&#xa0;cm. Collections were located in the head (<i>n</i> = 2), body (<i>n</i> = 5), tail (<i>n</i> = 2), and body and tail (<i>n</i> = 12) of the pancreas. ETD was performed 5–24&#xa0;weeks after an episode of acute necrotizing pancreatitis. Technical success was achieved in all patients (100%). Lumen-apposing metal stents were placed in 12 patients, multiple plastic stents in 7 patients, and a nasocystic drain in 2 patients. No immediate or early procedure-related complications or stent maldeployment were observed.</p> Conclusions <p>ETD of WON using an FVE is safe and effective in patients in whom drainage using a conventional oblique-viewing echoendoscope is technically challenging or unsuccessful.</p>