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

Background: 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 patients with malignant obstructive jaundice who underwent PTBD between January 2018 and December 2025. Patients were stratified based on the imaging modality used for the bile duct puncture (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. Results: A total of 133 patients (163 PTBD procedures) were included. 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 min vs. 56.6 ± 6 min; p < 0.001) compared to F-PTBD. Both techniques had comparable technical success rates (91.1% vs. 82.2%; p = 0.158). Complications occurred in 10.2% of patients in the F-PTBD group and 6.7% in the US-PTBD group, with no statistically significant difference between groups (p = 0.489). Major complications, including bleeding and cholangitis, occurred exclusively in the F-PTBD cohort. US-PTBD resulted in fewer Glisson capsule punctures, suggesting reduced procedural trauma. Conclusions: Although a significant access side imbalance was present between cohorts, 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.