Comparison of percutaneous transhepatic biliary drainage (PTBD) versus endoscopic ultrasonography (EUS) guided hepaticogastrostomy (HGS) in malignant hilar biliary obstruction: a randomized controlled trial

The primary treatment of jaundice secondary to a malignancy hilar biliary obstruction (MHBO) is stenting during endoscopic retrograde cholangiopancreatography. However, ERCP can fail or sometimes not feasible due to duodenal obstruction or  difficulty in passing guidewire across the stricture. In such cases, percutaneous transhepatic biliary drainage (PTBD) is most commonly performed for decades and is recommended second line in most guidelines.  EUS guided biliary drainage procedures have been recognized as an appealing alternative to PTBD. Amongst them, EUS Hepaticogastrostomy (HGS) is the only technically possible method available for MHBO. Both EU-HGS and PTBD are technically available alternatives in MHBO cases with failed ERCP. But in literature, there are only retrospective studies with heterogenous cohort. Hence, we plan to conduct a prospective randomized study with a homogenous cohort comparing the outcomes between EUS guided hepaticogastrostomy and PTBD, as a second line management for biliary drainage in MHBO cases with failed primary ERCP.