Endoscopic transmural drainage by using endoscopic ultrasound (EUS) guidance is not always safe because of the risk of bleeding and perforation. Additionally, the effective area of the EUS-guided procedure using a large diameter needle is relatively narrow. We evaluated the effectiveness and safety of EUS-guided drainage using fine needle and stiff fine guidewire without electrocautery. From November 2006 to July 2008, EUS-guided transmural drainage was performed in six consecutive patients for peripancreatic fluid collections. Puncture via EUS was performed by using a 22-gauge needle. A 0.018-inch guidewire was advanced through the needle and into the peripancreatic fluid collections. After the puncture site was dilated, a 6 Fr tube was immersed in the peripancreatic fluid collections. Five of six patients were successfully drained and treated effectively. One patient was unable to be drained because the dilator could not penetrate the gastric wall. The 22-gauge fine needle and stiff fine guidewire technique can be an alternative to the standard method for difficult puncture sites and risky cases.