Percutaneous transhepatic cholangioscopy combined with endoscopic retrograde cholangiopancreatography for bilateral biliary bridge drainage for malignant biliary obstruction

Biliary drainage in advanced malignant hilar biliary obstruction (MHBO) is challenging, especially with Bismuth-Corlette III–IV [1]. By placing a bridge stent between the left and right hepatic ducts, the non-communication system in MHBO can be drained, which is potentially a very promising biliary drainage strategy for MHBO [2]. However, due to the complexity of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) technology, reports on EUS-HGS bridge drainage are still limited. We report a novel approach to bridge bilateral hepatic duct drainage using ultrasound-guided percutaneous transhepatic cholangioscopy (PTCS) combined with endoscopic retrograde cholangiopancreatography (ERCP) in MHBO.