Patients with Roux-en-Y gastric bypass (RYGB) pose distinct challenges to performing ERCP. We propose an alternative endoscopic approach that uses EUS to gain PEG access to the excluded stomach in patients with RYGB anatomy. This video (Fig. 1; Video 1, available online at www.giejournal.org) describes an EUS-directed transgastric ERCP (EDGE) in 6 patients with RYGB anatomy (5 women, 1 man, average age 50.7 years) with biliary disease done by 2 expert biliary endoscopists. The EDGE technique is divided into 2 stages performed during separate endoscopic sessions, with mean procedure times of 81 and 98 minutes. The first stage of the procedure involved placement of a 16F PEG tube into the excluded stomach by using EUS guidance. During the second stage, ERCP was performed in an antegrade fashion through the fashioned gastrostomy after replacement of the PEG tube with a transcutaneous, fully covered, metal esophageal stent. EUS-guided access to the excluded remnant stomach was successful in all 6 patients (100%). Antegrade ERCP was successfully achieved in all 6 patients (100%), with a mean 5.8 days between the 2 stages. Given the high success rates of our recent experience, we propose that EDGE may provide a cost-effective, minimally invasive option for a common problem in a growing patient demographic.