Background <p>Immunoglobulin G4 (IgG4)-related pancreatobiliary disease typically manifests as obstructive jaundice, complicating therapeutic choices. Glucocorticoids (GCs) are the primary treatment with many challenges, including high recurrence rates and patient tolerance variability. Endoscopic biliary drainage (EBD) is used to alleviate obstruction, but its role during treatment in IgG4-related pancreatobiliary disease is still contested. There remains a paucity of research comparing the potential benefits of combination therapy with GCs and EBD versus GCs monotherapy.</p> Methods <p>This retrospective study divided 55 IgG4-related pancreatobiliary disease patients into two groups: GCs and GCs + EBD groups. We collected clinical data at the 1st, 3rd, 6th, and 12th months post-treatment to compare treatment efficacy, complication rates, and recurrence. Furthermore, logistic regression was used to analyze independent risk factors for recurrence.</p> Results <p>The results demonstrated that both treatment regimens significantly reduced total bilirubin (TBIL) and IgG4 levels within one year. The common bile duct diameter significantly decreased at the 6th and 12th months post-treatment compared to baseline. Except for significantly greater TBIL improvement in the GCs+EBD group at the 12th month, no other statistically significant differences were observed between groups. No statistically significant difference was observed in the cumulative recurrence rate within one year after treatment between the GCs and GCs+EBD groups. Finally, we identified elevated baseline IgG4 levels as an independent risk factor for post-treatment recurrence.</p> Conclusions <p>The combination therapy of GCs and EBD did not exhibit significant differences in immunologic remission, complication rates, or recurrence compared with GCs monotherapy for IgG4-related pancreatobiliary disease. Nonetheless, EBD showed certain benefits in alleviating biliary obstruction.</p>