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Even if insertion is feasible, the worse maneuverability of the endoscope and the restriction in available devices and techniques could complicate the procedure. Recently, endoscopic ultrasound\u2010guided antegrade intervention (EUS\u2010AG) has been reported as a useful management method for biliary diseases, especially in patients with surgically altered anatomy. In EUS\u2010AG, the biliary disease is managed in an antegrade fashion through a temporal fistula created under EUS guidance between the intrahepatic biliary duct and upper intestine. 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