Combined ERCP and transhepatic endoscopic ultrasound-guided stent placement for biliary drainage in malignant hilar obstruction: not too good to be true

Palliative biliary drainage is the mainstay of treatment for malignant hilar biliary obstruction (MHBO). Unresectable MHBO includes varying degrees of anatomical complexity, defined by the Bismuth classification. Higher Bismuth grades correspond to greater involvement of main and segmental hepatic bile ducts bilaterally. Complete drainage of complex MHBO improves patient outcomes; however, complete drainage in high-grade MHBO is not only...