Background and Objectives:Endoscopic retrograde cholangiopancreatography (ERCP) is still the most preferred method in Indonesia for patients with malignant obstructive jaundice. The role of therapeutic intervention endoscopic ultrasound (EUS) is still debatable regarding cost, availability, and hospital investment.Methods:Therapeutic intervention EUS cases were reviewed from our EUS hospital database within 2 years period. The EUS equipment was an Olympus JF UCT 180 EUS scope which was connected to an Aloka IPF-1701C ultrasound machine (Tokyo, Japan).Results:Of six patients who underwent therapeutic intervention EUS procedures, a 67-year-old male was referred with biliary obstruction due to duodenal malignancy with previous history of Billroth II operation. The papilla is placed at the duodenal bulb. Previous ERCP using the forward viewing scope was failed to attempt cannulation because of altered papilla due to advanced tumor. EUS-guided biliary drainage was then performed without any difficulty and a lumen-apposing metal stent (Hanaro stent) is placed from the duodenal bulb wall to the common bile duct. During follow-up, there was cholangitis complication which can be managed by antibiotic treatment. The bilirubin level went down within few days.Conclusion:EUS-guided biliary drainage case example has shown a high impact in gastroenterology practice in Indonesia which represents the biggest Southeast Asian country. However, the need of training curriculum has to be considered despite the cost and hospital investment.