Endoscopic biliary intervention is going to advance day by day, especially in endoscopic ultrasonography (EUS) guided procedures.Recent reported EUS-guided biliary interventions were biliary drainage (EUS-BD), rendezvous methods for biliary cannulation (EUS-RV) and gallbladder drainage (EUS-GBD).In this lecture, I will introduce the recent advance in EUS-BD.Most cases of EUS-BD were performed as a salvage therapy for the cases with failed or impossible to conventional endoscopic trans-papillary biliary drainage.There are 2 routes of EUS-BD; transgastric (hepatico-gastrostomy: EUS-HGS) and trans-duodenal (choledocho-duodenostomy: EUSCDS).However, almost reported studies were small.Recent large-scale international retrospective study including over 200 cases was presented at DDW 2011.This study reported the safety and efficacy of EUS-BD as salvage therapy, and additionally showed the safety of covered metallic stent to prevent peritonitis due to bile leak.Recent development of HGS was specific metallic stent for this procedure.There was only one Japanese study of EUS-CDS as a first-line therapy and the authors concluded that EUS-CDS might become an alternative therapy for unresectable distal biliary obstruction.We should determine the availability of EUS-BD as standard technique.