Cholangiocarcinoma (CCA) shows marked interpatient heterogeneity in chemotherapy response, highlighting the need for physiologically relevant, standardized, and reproducible in vitro models for individualized drug screening. However, Matrigel-based organoid models lack hepatobiliary extracellular matrix cues, and many bioprinting strategies rely on dissociated or fragmented organoids, disrupting native architecture and spatial organization. To address these limitations, we developed a composite bioink for direct bioprinting of patient-derived cholangiocarcinoma organoids (CCAOs) fragments that retained multicellular organization, enabling standardized culture, imaging, and drug-response evaluation. Although decellularized liver matrix (DLM) was used to reconstruct the tissue-specific microenvironment, its weak gelation, poor mechanics, and limited printability restricted application. Tris(2,2'-bipyridyl)ruthenium(II)/sodium persulfate (Ru/SPS) and gelatin methacryloyl (GelMA) were introduced to improve photocrosslinking, mechanical support, and printability. DLM retained key hepatic extracellular matrix components, including collagen, fibronectin, laminin, and glycosaminoglycans. With GelMA and Ru/SPS, the bioink achieved rapid visible-light crosslinking (405 nm, 50 s), tunable mechanical properties, and good extrusion-printing compatibility. Among the tested formulations, the DLM-Ru/SPS:GelMA (4:1) group showed the best balance of printability, transparency, and organoid-compatible microstructure. Using this optimized bioink, organoid fragments were patterned and reassembled into viable spheroids while retaining key cholangiocarcinoma features, and maintained high viability (>80%). The platform also enabled reproducible drug-response assessment, showing dose-dependent cisplatin sensitivity and enhanced cytotoxicity with cisplatin-gemcitabine treatment. In summary, this study established a DLM-based direct bioprinting platform for cholangiocarcinoma organoids and a standardized system for individualized therapeutic evaluation.