In terms of endoscopic biliary drainage, several novel techniques have been reported by skilled endoscopists. Ultraslim forward-viewing endoscope is useful for transnasal endoscopic biliary drainage without conscious sedation for the treatment of acute cholangitis. Endoscopic transpapillary gallbladder drainage in patients with acute cholecystitis in which percutaneous transhepatic approach is contraindicated or anatomically impossible. Recently, several endoscopists report on the EUS-guided

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... e duct drainage and gallbladder drainage. Concerning endoscopic lithotripsy, endoscopic sphincterotomy combined with large balloon dilation is effective for removal of large bile duct stones without serious complication. EHL using a mother-baby peroral cholangioscope are used for the crushing the huge stone. However, it needs two skilled endoscopists and two light sources. Recently, EHL using a ultraslim endoscope is performed by a endoscopist. Balloon enteroscope enables to perform the removal of bile duct stones even in patients with Roux-en-Y anastomosis.