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
Research background

Percutaneous transhepatic cholangiography is a diagnostic and therapeutic procedure. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a novel technique that allows BD whose technicality, success rate, and outcomes are not negligible.

Research motivation

We aimed to compare the technical details and outcomes of 132 studies concerning interventional BD procedures in patients with obstructive cholangiopathy. We conducted a systematic review of six studies that met the inclusion criteria.

Research objectives

To assess the suitability and appropriability of different clinical biliary interventions in achieving optimal BD for obstructive cholangiopathy.

Research methods

An extensive systematic review was independently conducted by two investigators using an electronic search of different databases, including PubMed, Embase,, the Cochrane library, Scopus, and Google Scholar, using the guidelines for Preferred Reporting Items for Systematic reviews and Meta-Analyses to identify studies comparing percutaneous transhepatic BD (PTBD) and EUS-BD.

Research results

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 in the EUS-BD and PTBD groups, respectively; P = 0.002) at the postprocedural 7-d follow-up. There were no significant differences in the complication rates between the PTBD and EUS-BD groups (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 rate of index procedure (39.2% vs 18.2%, respectively).

Research conclusions

EUS-BD might be considered as a first-line BD treatment instead of PTBD if the outcomes of clinical studies are favorable and the technical approach is simplified.

Research perspectives

EUS-BD following failed ERCP was superior to PTBD in patients with obstructive cholangiopathy.