{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T23:15:58Z","timestamp":1781133358801,"version":"3.54.1"},"reference-count":34,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T00:00:00Z","timestamp":1772236800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: After a failed endoscopic retrograde cholangiopancreatography (ERCP) for malignant biliary obstruction (MBO), second-line drainage is performed with endoscopic ultrasound-guided biliary drainage (EUS-BD) or percutaneous transhepatic biliary drainage (PTBD). We compared their effectiveness, safety, and short-term survival. Methods: We conducted a single-center retrospective cohort of 101 adults with MBO after they had experienced a failed ERCP (EUS-BD n = 37; PTBD n = 64). Allocation was non-randomized and driven by operational availability. Baseline laboratory tests (complete blood count, platelets, and C-reactive protein) and derived indices (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], lymphocyte-to-monocyte ratio [LMR], systemic immune-inflammation index [SII], systemic inflammation response index [SIRI], neutrophil-to-platelet score [NPS], and lymphocyte-to-CRP ratio [LCR]) were compared. Outcomes that were a technical success include: an early biochemical response (bilirubin reduction), complications (Clavien\u2013Dindo), length of stay (LOS), and overall survival (OS). Between-group comparisons used the two-sided Mann\u2013Whitney U test (continuous) and Fisher\u2019s exact (binary) test. Survival was assessed by the Kaplan\u2013Meier estimator using log-rank testing. To address later adoption of EUS-BD, we also estimated a restricted mean survival time of 180 days (RMST_0\u2013180) with 95% confidence intervals (CIs). Results: Baseline inflammatory markers and composite indices were similar; baseline total bilirubin was higher in PTBD. The technical success was 100% in both groups. Early biochemical response was 86.5% after EUS-BD vs. 78.1% after PTBD (p = 0.43). Any complication occurred in 29.7% vs. 12.5% (p = 0.04); major complications (Clavien\u2013Dindo \u2265 III) occurred in 10.8% vs. 0% (p = 0.02), respectively; and the LOS did not differ (p = 0.21). OS favored EUS-BD (median 143 vs. 54 days and log-rank p = 0.012). RMST_0\u2013180 was 111.1 days for EUS-BD vs. 71.4 days for PTBD (difference + 39.6 days; 95% CI 11.3\u201365.9). Conclusions: After a failed ERCP for MBO, EUS-BD and PTBD achieved universal technical success and similar early biochemical responses, but EUS-BD was associated with higher complication rates and a significantly longer six-month survival. These findings support the individualized selection balancing procedural risk with the anticipated survival benefit and highlight the need for prospective comparative studies.<\/jats:p>","DOI":"10.3390\/cancers18050783","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T16:18:45Z","timestamp":1772554725000},"page":"783","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Endoscopic Ultrasound-Guided Versus Percutaneous Transhepatic Biliary Drainage After Failed Endoscopic Retrograde Cholangiopancreatography in Malignant Biliary Obstruction: A Single-Center Retrospective Cohort"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5566-6745","authenticated-orcid":false,"given":"Wojciech","family":"Ciesielski","sequence":"first","affiliation":[{"name":"Department of General and Transplant Surgery, Medical University of \u0141\u00f3d\u017a, 90-153 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9818-5637","authenticated-orcid":false,"given":"\u0141ukasz","family":"Durko","sequence":"additional","affiliation":[{"name":"Department of Digestive Tract Diseases, Medical University of \u0141\u00f3d\u017a, 90-153 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludomir","family":"Stefa\u0144czyk","sequence":"additional","affiliation":[{"name":"1st Department of Radiology and Diagnostic Imaging, Medical University of \u0141\u00f3d\u017a, 90-153 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Dobek","sequence":"additional","affiliation":[{"name":"1st Department of Radiology and Diagnostic Imaging, Medical University of \u0141\u00f3d\u017a, 90-153 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7336-7096","authenticated-orcid":false,"given":"Anna","family":"Bulicz","sequence":"additional","affiliation":[{"name":"Department of General and Transplant Surgery, Medical University of \u0141\u00f3d\u017a, 90-153 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia","family":"Wojnicka","sequence":"additional","affiliation":[{"name":"Department of General and Transplant Surgery, Medical University of \u0141\u00f3d\u017a, 90-153 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuzanna","family":"Sosnowska","sequence":"additional","affiliation":[{"name":"Department of General and Transplant Surgery, Medical University of \u0141\u00f3d\u017a, 90-153 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0158-8066","authenticated-orcid":false,"given":"Agata","family":"Grochowska","sequence":"additional","affiliation":[{"name":"Department of General and Transplant Surgery, Medical University of \u0141\u00f3d\u017a, 90-153 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janusz","family":"Strzelczyk","sequence":"additional","affiliation":[{"name":"Department of General and Transplant Surgery, Medical University of \u0141\u00f3d\u017a, 90-153 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Hogendorf","sequence":"additional","affiliation":[{"name":"Department of General and Transplant Surgery, Medical University of \u0141\u00f3d\u017a, 90-153 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Durczy\u0144ski","sequence":"additional","affiliation":[{"name":"Department of General and Transplant Surgery, Medical University of \u0141\u00f3d\u017a, 90-153 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Klimczak","sequence":"additional","affiliation":[{"name":"Department of General and Transplant Surgery, Medical University of \u0141\u00f3d\u017a, 90-153 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,28]]},"reference":[{"key":"ref_1","unstructured":"Walker, H.K., Hall, W.D., and Hurst, J.W. 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