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

ABSTRACT 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.