Endoscopic biliary drainage (EBD) does not seem to be superior to percutaneous transhepatic biliary drainage (PTBD) for patients with perihilar cholangiocarcinoma (CCA), according to a study recently published in Clinics.

“There is not enough data to establish a consensus, and in each case, several aspects are taken into account before making this decision, such as anatomic localization of the obstruction, device availability in the referred medical center, local expertise, preoperative or palliative purposes, and patient status and preference,” the authors wrote.

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This systematic review and meta-analysis based its protocol on the Cochrane Handbook of Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines and included 17 different publications with a total of 2284 patients.

Slightly more patients underwent an EBD, while the remaining had a PTBD. Overall, both procedures demonstrated statistically similar technical success. In patients with resectable CCA, those who underwent a PTBD experienced less crossover, overall complications, and pancreatitis posterior to the procedure.

Among the participants that underwent biliary drainage as a palliative method, the PTBD cohort had greater clinical success rates while also reporting fewer cases of postprocedure cholangitis.

The EBD approach only demonstrated better results regarding the length of hospitalization, with a reduction in the stay with a reduced risk of -2.89, compared to the PTBD technique.

Moreover, the safety profile of both procedures is comparable, as the researchers did not find a statistical difference regarding postdrainage major complications and bleeding or seeding metastases.

Although physicians should take into account these results when selecting an approach, there are still many aspects to consider, and the final decision must be personalized for each case.

“Nevertheless, we believe that having internal drainage with EBD in lieu of an external 1 provided by a PTBD may be more comfortable for the patient as shown in studies that have compared ultrasound-guided gallbladder drainage (i.e., internal drainage) versus percutaneous cholecystostomy tube for the management of acute cholecystitis in nonsurgical candidates,” the authors noted.


Flaksbaum C, Turiani D, Braga I, et al. Endoscopic biliary darinage (EBD) versus percutaneous transhepatic biliary drainage (PTBD) for biliary drainage in patients with perihilar cholangiocarcinoma (PCCA): a systematic review and meta-analysis. Clinics. Published online January 19, 2023. doi:10.1016/j.clinsp.2022.100163