Proximal bile duct carcinoma is surgically irresectable in most patients and some form of palliative drainage is necessary. Percutaneous transhepatic drainage for this condition has been performed in eight patients through internal and external drainage. Five patients had an adequate drainage with a mean palliative drainage period of 11 months, the longest period being 21 months. The other three patients, with a mean age of 88 years, died within four weeks due to terminal disease. The direct transhepatic approach seems an attractive alternative to surgical bypass procedures as a palliative treatment. In particular, if the tumor involves both hepatic ducts, combined left and right hepatic duct drainage offers a new possibility in palliative treatment.