In cases with hilar strictures in the liver, sufficient bile duct drainage by conventional ERCP might be challenging or impossible. Traditionally, percutaneous transhepatic cholangiography (PTC) has served as salvage therapy, but the results are often suboptimal and external bile duct drainage decreases the quality of life for patients. Recently, EUS-guided transgastric access to the bile ducts has been introduced as a minimal invasive alternative to PTC [1]. Furthermore, when an EUS-guided access to the bile ducts has been achieved, several possibilities for internal drainage are available including the establishment of a hepaticogastrostomy, antegrade stenting, or rendezvous.