Endoscopic ultrasound (EUS)-guided transluminal drainage of obstructed bile duct with conventional metal and plastic stents has been in practice for several years, but this modality carries its own potential complications and obstacles. Nevertheless, the novel Hot AXIOS stent (Boston Scientific Corp., Marlborough, MA) has been shown to overcome some of those factors, which justifies its application in a variety of clinical indications, such as EUS-guided choledochoduodenostomy (EUS-CDS) for biliary drainage after failed endoscopic retrograde cholangiopancreatography. We present a case of EUS-CDS with an electrocautery enhanced lumen-apposing stent for biliary drainage.