Comparative Outcomes of Ultrasound-Guided Versus Fluoroscopy-Guided Percutaneous Transhepatic Biliary Drainage (PTBD) Due to Malignant Obstructive Jaundice: A Single-Center Retrospective Analysis

Background/Objectives: Percutaneous transhepatic biliary drainage (PTBD) remains a cornerstone in managing obstructive jaundice, particularly when endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful or contraindicated. This study aims to compare ultrasound-guided (US-PTBD) and fluoroscopy-guided (F-PTBD) techniques regarding procedural time, radiation exposure, technical success, and complication rates. Methods: This retrospective, single-center study included 133 patients (163 PTBD procedures) with malignant obstructive jaundice who underwent PTBD between January 2018 and December 2024. Patients were stratified based on the guidance method (US-PTBD vs. F-PTBD). Procedural characteristics, including dose-area product (DAP), fluoroscopy time, complication rates, and technical success, were analyzed using statistical methods appropriate for continuous and categorical data. The study protocol was approved by the local Ethics Committee. Results: US-PTBD demonstrated significantly lower DAP (4.1 ± 1.9 Gy·cm² vs. 6.2 ± 1.5 Gy·cm²; p < 0.001) and shorter procedure time (42 ± 7 minutes vs. 56.6 ± 6 minutes; p < 0.001) compared to F-PTBD. Both techniques had comparable technical success rates (91.1% vs. 82.2%; p = 0.158). Complication rates were higher in the F-PTBD group (10.2% vs. 6.7%), with major complications, including bleeding and cholangitis, occurring exclusively in the F-PTBD cohort. US-PTBD resulted in fewer Glisson capsule punctures, suggesting reduced procedural trauma. Conclusions: US-PTBD offers distinct advantages over F-PTBD, including reduced radiation exposure, shorter procedure times, and a comparable safety profile. These findings highlight the potential of US guidance as a safer alternative for PTBD, particularly in patients with coagulopathy or complex anatomy. Further multicenter studies with larger populations are warranted to confirm these benefits and refine patient selection criteria.