Abstract: Objective The aim of this study was to compare the efficacy and safety of endoscopic ultrasound-guided biliary drainage (EUS-BD) and percutaneous transhepatic biliary drainage (PTBD) in the treatment of patients with malignant obstructive jaundice after failure of endoscopic retrograde cholangiopancreatography (ERCP). Methods 75 patients with malignant obstructive jaundice (pancreatic carcinoma in 15, vater ampulla carcinoma in 12, bile duct carcinaoma in 27, gall bladder carcinoma in 9, gastrointestinal cancer in 11, and non-Hodgkin lymphoma in 1) proven by B-ultrasound, CT or MRCP were recruited in our hospital between January 2013 and December 2018. All the patients had failed ERCP, and 40 were retreated by EUS-BD, and 35 received PTBD. Results The operation success rate in 40 EUS-BD-treated patients was 92.5%, not significantly different as compared to 80.0% in 35 PTBD-treated patients , and the operational times were also not significantly different between the two groups [(50.8±28.4)min vs. (54.7±25.2)min, P>0.05); after treatment, serum bilirubin level was(138.7±50.2)μmol/L, significantly lower than (162.4±60.2)μmol/L, while serum albumin level in EUS-BD-treated group was (34.8±3.7)g/L, much higher than [(32.1±4.6)g/L,P<0.05] in TPBD-treated group; the incidence of post-operational complications in the former was 7.5%(3/40), including biliary hemorrhage in 2, acute cholangitis in 1, and it was 22.9%(8/35, P<0.05) in the latter, including biliary hemorrhage in 3, subhepatic capsular hemorrhage in 1, bile peritonitis in 1, bile leakage in 1 and biliary tract infection in 2. Conclusion The alternative application of EUS-BD or PTBD in failed ERCP patients is feasible, and might temporarily improve jaundice subside.

Key words: Malignant obstructive jaundice, Endoscopic retrograde cholangiopancreatography, Endoscopic ultrasound-guided biliary drainage, Percutaneous transhepatic biliary drainage, Therapy