An apparatus for insertion into a body through a working channel of an endoscope includes a catheter including a dilator, a guide tube disposed in a lumen of the catheter, and a handle including a puncturing actuator operatively coupled to the proximal end of the guide tube. The dilator may be a cautery device and/or a balloon. The apparatus may also include a stylet needle that includes a cutting distal end for puncturing tissue and extends through a lumen in the guide tube. The handle may further include a stopper detachably coupled to the puncturing actuator to fix a position of the puncturing actuator on the handle, and moveable on the handle independently of the puncturing actuator when detached from the puncturing actuator. The disclosed embodiments also include a method for forming a passageway in a wall of a hollow body organ using the apparatus.