An endoscope accessory, such as a coupler device, is provided that includes a main body with a visualization section for allowing viewing of tissue by the endoscope and a proximal end configured for attachment to a distal end portion of the endoscope. The device includes a passage within the main body having an exit portal and a proximal end aligned with the working channel of the endoscope. An instrument passing through the passage is capable of angular adjustment relative to the main body of the coupler device by actuation of the endoscope.