 Background: Malignant biliary obstruction at the liver hilum is caused by a heterogeneous group of tumours that include cholangiocarcinoma, gallbladder cancer CaGB and metastatic cancer. CaGB is the commonest cause of malignant hilar obstruction in India 1. Jaundice is the second most common presentation and occurs in 30-60 of patients with CaGB 2-5. It is obstructive in nature and frequently associated with pruritis, which is very disturbing for the patients. Most patients with CaGB with surgical obstructive jaundice are not amenable to a curative surgical resection 5 and hence effective palliation is the goal of treatment. Although surgical bilioenteric bypass has been the traditional palliative approach 6, it is associated with substantial morbidity and mortality. Non-operative alternatives in the form of percutaneous and endoscopic drainage are available 7-8. Unilateral drainage of single liver lobe may be sufficient to palliate the jaundice and, pruritis and improve the quality of life 9-15. A few trials have shown that endoscopic drainage is better than percutaneous drainage in patients with lower end bile duct obstruction due to pancreatic and periampullary cancer. However, the scenario is quite different in patients with hilar malignant obstruction. Endoscopic drainage is associated with a higher incidence of cholangitis in patients with a block at the confluence Bismuth types 2 and 3 and the success rate varies from 40 to 80, while percutaneous drainage may be associated with complications such as biliary leak and bleeding. There has been no randomized trial comparing endoscopic and percutaneous drainage in patients with malignant hilar obstruction alone. 