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For unresectable malignant hilar biliary obstructions, drainage of ≥50% of the liver volume is recommended [1]. Endoscopic transpapillary biliary drainage is the current standard treatment for malignant hilar biliary obstruction. Cholangioscopy-assisted guidewire placement is a useful method for biliary drainage, which can be used even in patients without contrast-filled images [2] In recent years, the use of endoscopic ultrasound-guided biliary drainage (EUSBD) for malignant hilar biliary obstruction has increasingly been reported. However, it is technically challenging, especially in patients with right intrahepatic bile duct (IHBD) obstruction. Herein, we report the use of combined conventional transpapillary drainage and EUS-guided hepaticoduodenostomy (EUS-HDS) in a patient with malignant hilar biliary obstruction after failed manipulation under cholangioscopy guidance. E-Videos

Combined transpapillary drainage and endoscopic ultrasound-guided hepaticoduodenostomy after failed manipulation under cholangioscopy guidance