Efficacy of Drainage Combining Endoscopic Retrograde Cholangiopancreatography With Endoscopic Ultrasound-guided Biliary Drainage for Difficult-to-Control Cholangitis in Patients With Hilar Cholangiocarcinoma.

Objectives: Hilar cholangiocarcinoma often results in repeated early stent dysfunction and difficult-to-control cholangitis after drainage using endoscopic retrograde cholangiopancreatography (ERCP). In this study, we evaluated the effectiveness of additional drainage using endoscopic ultrasound-guided biliary drainage (EUS-BD) in patients with hilar cholangiocarcinoma who had difficult-to-control cholangitis after transpapillary drainage with ERCP alone. Methods: We retrospectively evaluated 20 patients with hilar cholangiocarcinoma who had difficult-to-control cholangitis after transpapillary drainage with ERCP at our hospital between 2017 and 2025 and therefore underwent additional drainage using EUS-BD. We evaluated the time to recurrent biliary obstruction (TRBO) just before and after combined ERCP and EUS-BD in these patients. Results: The Bismuth classification of stenosis was II in four cases (20.0%), IIIa in five cases (25.0%), IIIb in one case (5.0%), and IV in 10 cases (50.0%). The median (95% confidence interval) TRBO biliary obstruction just before and just after additional drainage with EUS-BD was 16.5 days (7.0-27.0) and 91.0 days (53.0-NR), respectively, and additional drainage with EUS-BD significantly prolonged stent patency. Conclusions: Combining ERCP with EUS-BD for drainage was effective in patients with hilar cholangiocarcinoma who had stent dysfunction due to cholangitis that was difficult to control using transpapillary drainage with ERCP alone.