Objective: To assess the clinical application value of biliary stent placement for hilar cholangiocarcinoma via percutaneous transhepatic biliary drainage (PTBD) or endoscopic retrograde cholangiopancreatography (ERCP). Methods: The clinical data of 75 patients with hilar cholangiocarcinoma undergoing metal biliary stent placement were retrospectively analyzed. Results: In PTBD group, stent placement was performed in 29 cases and stents were successfully placed in 26 of the 29 cases (89.7%), the incidence of complications was 6.5%, and the median survival time was 26 weeks respectively. In ERCP group, stents were successfully placed in 38 of the 44 cases (86.4%), the incidence of complications was 13.6%, and the median survival time was 28 weeks respectively. The median survival time of both the unilateral placement group (29 cases) and bilateral placement group (35 cases) was 28 weeks. Conclusion: Biliary stent placement for hilar cholangiocarcinoma can achieve demonstrable efficacy either by PTBD or ERCP. Unilateral placement is preferred when using PTBD, while bilateral placement is recommended when performing ERCP.