![]() Obstructive jaundice can lead to adverse events such as delayed tumor treatment, acute cholangitis, poor quality of life, and even death if not handled promptly. Obstructive jaundice due to malignant biliary strictures is usually secondary to pancreatic cancer, ampullary cancer, or cholangiocarcinoma. This meta-analysis indicates that endoscopic biliary drainage (EUS-BD) is equally effective but safer in terms of acute and total adverse events than percutaneous transhepatic biliary drainage (PTC) for biliary decompression in patients with malignant biliary strictures who have failed an ERCP. Procedural adverse events (OR: 0.17 P = 0.03) and total adverse events (OR: 0.09 P < 0.01) were significantly different between the two groups however, delayed adverse events were nonsignificantly different (OR: 0.73 P = 0.97). There was no difference between technical (OR: 0.47 P = 0.27) and clinical (OR: 2.24 P = 0.51) success rates between EUS-PD and PTC groups. The odds ratios (ORs) and confidence intervals (CIs) were calculated. We compared the technical and clinical success rates and the acute, delayed, and total adverse events of EUS-BD with PTC. ![]() A total of ten studies were included, fulfilling the inclusion criteria, including four retrospective studies and six randomized controlled trials. ![]() We conducted a systematic review and meta-analysis of studies to compare the efficacy and safety of endoscopic and percutaneous biliary drainage for malignant biliary obstruction in patients with failed ERCP. EUS-guided biliary drainage (EUS-BD) and percutaneous transhepatic cholangiography biliary drainage (PTC) are the two alternate methods for biliary decompression in cases where ERCP fails.
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