Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2022; 28(27): 3514-3523
Published online Jul 21, 2022. doi: 10.3748/wjg.v28.i27.3514
Percutaneous transhepatic cholangiography vs endoscopic ultrasound-guided biliary drainage: A systematic review
Zeinab Hassan, Eyad Gadour
Zeinab Hassan, Internal Medicine, Stockport Hospitals NHS Foundation Trust, Manchester SK2 7JE, United Kingdom
Eyad Gadour, Department of Gastroenterology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster LA1 4RP, United Kingdom
Author contributions: Hassan Z contributed in study selection, data analysis, and writing of the manuscript; Gadour E contributed in study conception, analysis and interpretation of the data, and drafting of the manuscript; and all authors have approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Eyad Gadour, CCST, FRCP, MBBS, MRCP, Consultant Physician-Scientist, Department of Gastroenterology, University Hospitals of Morecambe Bay NHS Foundation Trust, Royal Lancaster Infirmary, Lancaster LA1 4RP, United Kingdom.
Received: November 22, 2021
Peer-review started: November 23, 2021
First decision: January 9, 2022
Revised: January 21, 2022
Accepted: June 23, 2022
Article in press: June 23, 2022
Published online: July 21, 2022

Percutaneous transhepatic cholangiography is a diagnostic and therapeutic procedure that involves inserting a needle into the biliary tree, followed by the immediate insertion of a catheter. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a novel technique that allows BD by echoendoscopy and fluoroscopy using a stent from the biliary tree to the gastrointestinal tract.


To compare the technical aspects and outcomes of percutaneous transhepatic BD (PTBD) and EUS-BD.


Different databases, including PubMed, Embase,, the Cochrane library, Scopus, and Google Scholar, were searched according to the guidelines for Preferred Reporting Items for Systematic reviews and Meta-Analyses to obtain studies comparing PTBD and EUS-BD.


Among the six studies that fulfilled the inclusion criteria, PTBD patients underwent significantly more reinterventions (4.9 vs 1.3), experienced more postprocedural pain (4.1 vs 1.9), and experienced more late adverse events (53.8% vs 6.6%) than EUS-BD patients. There was a significant reduction in the total bilirubin levels in both the groups (16.4-3.3 μmol/L and 17.2-3.8 μmol/L for EUS-BD and PTBD, respectively; P = 0.002) at the 7-d follow-up. There were no significant differences observed in the complication rates between PTBD and EUS-BD (3.3 vs 3.8). PTBD was associated with a higher adverse event rate than EUS-BD in all the procedures, including reinterventions (80.4% vs 15.7%, respectively) and a higher index procedure (39.2% vs 18.2%, respectively).


The findings of this systematic review revealed that EUS-BD is linked with a higher rate of effective BD and a more manageable procedure-related adverse event profile than PTBD. These findings highlight the evidence for successful EUS-BD implementation.

Keywords: Percutaneous transhepatic cholangiography, Endoscopic ultrasound, Biliary drainage, Obstructive cholangiopathy

Core Tip: Endoscopic transpapillary biliary drainage (BD) is the preferred approach for biliary decompression in patients with unresectable pancreatic cancer and obstructive jaundice. We conducted a systematic review of studies comparing the technical aspects and outcomes of two distinct approaches for BD: Endoscopic ultrasound-guided BD (EUS-BD) and percutaneous transhepatic BD (PTBD). The evaluation of six studies that fulfilled the inclusion criteria revealed that PTBD was associated with more reinterventions, postprocedural pain, and late adverse events compared with EUS-BD. Both procedures were associated with a significant reduction in the total bilirubin levels at the 7-d follow-up, and there were no significant differences in the complication rates between the two procedures. In summary, EUS-BD was associated with a higher rate of effective BD and manageable procedure-related adverse events compared with PTBD, highlighting its utility in successful BD.