EUS rendezvous was first described in 2004 as an alternative to achieve biliary drainage in cases of failed attempts by ERCP with good results. Biliary drainage was performed latter by some authors with the use of metallic stents inserted through a path created by using EUS guided puncture of dilated intra-hepatic biliary tree and proved to be a feasible and efficient method. A 45 year-old female with a post-cholecystectomy biliary stricture was submitted to a hepatojejunostomy and a Roux-en-Y reconstruction. One year later, the patient presented with obstructive jaundice. Laboratory data: Bilirrubin: 5 mg/dl (0,2 −1,0 mg/dl), direct bilirrubin: 3 mg/dl (< 0,3 mg/dl), alkaline phosphatase: 310 U/L (40 −129 U/L), GGTP: 230 U/L (8-61 U/L). Abdominal CT: Dilation of the intra and extrahepatic bile ducts. ERCP: Unsuccessful ERCP due to Roux-en-Y anatomy. EUS-guided identification of the left intra-hepatic duct was made using doppler, a puncture of the left hepatic duct with a 19G needle was performed. Injection of iodine-contrast was used to identify the biliary tree. A wire-guided catheter increased the orifice on the stomach. Without dilation, a partially covered metal stent was placed anterograde through the obstruction with appropriate drainage of iodine-contrast injected. After three months the stent was removed by single-balloon enteroscopy and using a snare. Endoscopic retrograde cholangiogram was obtained after stent removal and demonstrated to be normal. During follow-up a decrease on bilirrubin levels was seen and the patient had an uneventful evaluation. EUS guided biliary drainage is a minimally invasive procedure with high complexity that requires experience in therapeutic EUS and ERCP. EUS guided anterograde placement of SEMS is a new alternative to endoscopic access to the biliary tree in those patients with gastrointestinal tract surgical deviation. Prospective studies to assess feasibility and safety are necessary.