To investigate the biliary drainage-related cholangitis and other complications of percutaneous transhepatic biliary drainage (PTBD) in the management of Klatskin tumor (KT) compared with endoscopic biliary drainage (EBD).

Operative treatment combined with preoperative biliary drainage (PBD) has been established as a safe management strategy for KT. Preoperative cholangitis was an independent risk factor for patients undergoing resection for KT. However, controversy exists regarding the preferred technique for PBD.

Inclusion Criteria:

• Type II、III、IV Klatskin tumor patients;
• 18-90 years old

Exclusion Criteria:

• Unwillingness or inability to consent for the study;
• Coagulation dysfunction (INR> 1.3) and low peripheral blood platelet count(<50×109 / L) or using anti-coagulation drugs;
• Previous endoscopic sphincterectomy (EST) or endoscopic papillary balloon dilatation (EPBD);
• Any type of GI reconstruction;
• Combined with Mirizzi syndrome and intrahepatic bile duct stones;
• Preoperative coexistent diseases: acute pancreatitis, GI tract hemorrhage, severe liver disease, primary sclerosing cholangitis (PSC), septic shock;
• Biliary-duodenal fistula;
• Pregnant women