BACKGROUND The aims of this study were to compare the effectiveness of percutaneous drainage between pyogenic hepatic abscesses with and those without biliary communication and to evaluate the role of endoscopic biliary stent placement in the treatment of communicating abscesses. METHODS Sixty-one patients with hepatic abscesses underwent percutaneous drainage. For communicating abscesses refractory to drainage alone, endoscopic biliary stenting was performed. RESULTS After drainage, all patients showed improvement in their clinical condition and reduction in abscess size. Drainage alone completely cured abscesses in none of 10 patients with biliary communication and obstruction, in 3 of 10 with communication but without obstruction, and in 37 of 41 without communication. Endoscopic stenting was completely effective in all 7 patients with persistent discharge from a communicating abscess without biliary obstruction. CONCLUSIONS Percutaneous drainage is less effective for communicating abscesses without biliary obstruction than for noncommunicating abscesses. Endoscopic biliary stenting is recommended, if drainage does not achieve a cure.