Interest in EUS-guided biliary drainage is increasing and this approach is candidate to establish as an effective alternative to percutaneous transhepatic cholangiography, when endoscopic access to the papilla is  precluded because of duodenal stenosis, periampullary tumor invasion, or previous surgery; nevertheless this method is far from being standardized and  many technical issues need to be clarified. [1-6] We present hereby three cases from our experience which we think they can exemplify some of the choices and difficulties, that could be faced by the operators novice in EUS-guided drainage.