Purpose: ERCP, along with EUS, is widely used for benign and malignant biliary strictures. In many centers, ERCP with stent placement for biliary obstruction is performed prior to EUS. Evaluation of a biliary stricture with EUS usually requires insufflation of the EUS balloon at the papilla which could move the biliary stent proximally or distally. The aim of this study is to investigate the occurrence rate of potential stent migration as a direct consequence of performing EUS after ERCP. Methods: We conducted a retrospective chart review of all EUS cases preceded by ERCP for pancreatic or biliary indications done at our institution in the last 30 months. Patient's endoscopy reports, clinical course and outcomes were reviewed. We measured the biliary stent migration rates necessitating the need for repeat ERCP after the EUS for recurrent symptoms of biliary obstruction. Results: Among 206 patients who had an EUS for pancreatic or biliary disease, 74 (35.9%) also required an ERCP for abnormal liver function tests or abnormal diagnostic imaging. Twenty-nine (39.1%) of the 74 patients, required placement of a biliary stent. Four of these patients (13.8%) had stent migration creating recurrent symptoms, two of which, were within five days of having had EUS done. Of the 29 patients who received stents, the majority (15) were diagnosed with pancreatic cancer, (4) cholangiocarcinoma, (2) papillary cancer, (3) chronic pancreatitis(inflammatory mass), (2) benign strictures, (2) pancreatic pseudocysts, and (1) metastatic small-cell lung cancer. All 4 patients with stent migration had approximately a 1 cm sphinterotomy, balloon dilatation of the stricture, and 10 Fr × 10 cm stent placement. Three of the 4 had distal biliary strictures and one had a mid-CBD stricture. Of the 2 patients with stent migration within 5 days of the EUS, one was a proximal migration and the other a distal migration. Conclusions: Performing an EUS after biliary stent placement has a potential risk for proximal or distal biliary stent migration. Hence, we recommend reevaluation of the stent postion after deflating the EUS balloon to assess the stent's position prior to completion of the procedure, or performing EUS prior to the ERCP and stent placement. Purpose: ERCP, along with EUS, is widely used for benign and malignant biliary strictures. In many centers, ERCP with stent placement for biliary obstruction is performed prior to EUS. Evaluation of a biliary stricture with EUS usually requires insufflation of the EUS balloon at the papilla which could move the biliary stent proximally or distally. The aim of this study is to investigate the occurrence rate of potential stent migration as a direct consequence of performing EUS after ERCP. Methods: We conducted a retrospective chart review of all EUS cases preceded by ERCP for pancreatic or biliary indications done at our institution in the last 30 months. Patient's endoscopy reports, clinical course and outcomes were reviewed. We measured the biliary stent migration rates necessitating the need for repeat ERCP after the EUS for recurrent symptoms of biliary obstruction. Results: Among 206 patients who had an EUS for pancreatic or biliary disease, 74 (35.9%) also required an ERCP for abnormal liver function tests or abnormal diagnostic imaging. Twenty-nine (39.1%) of the 74 patients, required placement of a biliary stent. Four of these patients (13.8%) had stent migration creating recurrent symptoms, two of which, were within five days of having had EUS done. Of the 29 patients who received stents, the majority (15) were diagnosed with pancreatic cancer, (4) cholangiocarcinoma, (2) papillary cancer, (3) chronic pancreatitis(inflammatory mass), (2) benign strictures, (2) pancreatic pseudocysts, and (1) metastatic small-cell lung cancer. All 4 patients with stent migration had approximately a 1 cm sphinterotomy, balloon dilatation of the stricture, and 10 Fr × 10 cm stent placement. Three of the 4 had distal biliary strictures and one had a mid-CBD stricture. Of the 2 patients with stent migration within 5 days of the EUS, one was a proximal migration and the other a distal migration. Conclusions: Performing an EUS after biliary stent placement has a potential risk for proximal or distal biliary stent migration. Hence, we recommend reevaluation of the stent postion after deflating the EUS balloon to assess the stent's position prior to completion of the procedure, or performing EUS prior to the ERCP and stent placement.