Gastrointestinal EUS has become an important imaging modality. However, its role in pediatric chronic liver diseases is still poorly studied. The aim of our study was to asses its role in pediatric chronic liver diseases.Forty patients were included in the study on the basis of one or more of the following selection criteria: ultrasonographic or biopsy evidence of biliary pathology, autoimmune hepatitis non-responding to therapy or with high GGT, cryptogenic liver disease with or without high GGT or those with neonatal cholestasis with persisting or relapsing hepatobiliary symptoms.They were subjected to laboratory investigations, US, liver biopsy and EUS followed by ERCP for verification of results as the gold standard test. EUS and US agreed in most aspects with superiority of EUS regarding detection of CBD stones, dilatation, GB wall thickness, biliary mud, minute stones and in pancreatic assessment. Compared to ERCP, EUS had 100% sensitivity, PPV, specificity and NPV regarding the assessment of hepatobiliary tree. They were 100%, 66.7%, 97.4%, 100% respectively regarding pancreatic ductal system assessment (dilatations and tortousities). EUS had a unique ability in assessment of the pancreatic parenchyma detecting evidence of early chronic pancreatitis.It can be concluded that pediatric patients with chronic liver diseases with underlying biliary pathology can be well evaluated by EUS. Negative cases shouldn’t be subjected to further evaluation by ERCP and can be followed up by EUS if needed. Positive cases by EUS shouldn’t be followed by ERCP except if further therapeutic intervention is planned. Positive cases involving the pancreatic ductal system are better to be confirmed by ERCP. EUS can replace the diagnostic ERCP and minimize its role to the therapeutic approach.