EUS-guided biliary drainage has evolved as an alternative procedure with level 1 evidence for distal malignant biliary obstruction. Currently, the procedure is utilised in those with failed ERCP, those with duodenal stenosis, or those with post-surgical anatomy. The technique and technology has evolved over past few years, aided by availability of EUS-specific stents and accessories. EUS-BD is actually a grouping of multiple procedures with different access points and different exit points for the stents. Technical expertise involves learning tricks for each of the procedure, anticipating potential problems, and being ready to manage adverse events if they happen. A multi-disciplinary tea approach is essential for optimum patient outcome