الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Biliary drainage after failed ERCP can be performed by one of the following techniques; percutaneous transhepatic biliary drainage (either PTBD or PMBD), combined percutaneous and endoscopic technique (Rendezvous technique), endoscopic ultrasound guided biliary drainage (EUS-BD) and surgical bypass (Khashab MA, et al., 2015). EUS-BD has been increasingly used as a less invasive procedure compared to surgery or interventional radiology (Khashab MA et al., 2015). The aims of the current study are to compare technical success, clinical success, complications, costs and evaluate metallic stent patency between endoscopic ultrasound guided biliary drainage (EUS-BD) and percutaneous biliary drainage procedures (PTBD and PMBD) for malignant biliary obstruction after failed ERCP. This is a prospective comparative study included 60 patients with malignant biliary obstruction after failed ERCP and were randomly divided in three equal groups with male sex predominance. The age of patients ranged between 46 and 74 years. The commonest causes of malignant obstructive jaundice were pancreatic carcinoma, followed by cholangiocarcinoma, ampullary carcinoma and gall bladder carcinoma. Causes of failure of ERCP were papillary infiltration and difficult cannulation of the papilla and CBD, gastroduodenal invasion by the tumor, inability to pass the tumor stricture after successful CBD cannulation and previous gastroduodenal surgery. EUS-BD and PTBD procedures have similar technical success rate (100%). While, PMBD has less technical success rate (90%) as compared with EUS-BD and PTBD procedure due to failure of passage of the guidewire through the tumor stricture so the procedure changed to PTBD in two patients (10%) P=0.995.