Endoscopic Versus Percutaneous Transhepatic Biliary Drainage in Management of different Types of Hilar Common Bile duct Stricture

Background: Many different benign and malignant disorders can result in biliary strictures at the liver hilum. Hematologic, hepatic, renal, and cardiac dysfunction are just a few of the organ systems that may be impacted by biliary blockage, which changes normal physiology. Aim and objectives: To evaluate the effectiveness of endoscopic vs percutaneous transhepatic biliary drainage (PTBD) in treating various types of hilar common bile duct stricture. Patients and methods: Fifty individuals with hilar obstructive jaundice were hospitalized between June 2022 and September 2024 at the Gastroenterology and Hepatology Unit of the Department of Internal Medicine at Al-Hussein University Hospital. Clinical evaluation, laboratory results, imaging results, invasive procedures (endoscopic retrograde cholangiopancreatography, or ERCP), percutaneous transhepatic drainage, or rendez-vous drainage, and a postoperative laboratory follow-up of five to seven days. Results: Bismuth Corlette types and ERCP outcome were highly statistically significantly correlated (P<0.001). Of patients who had a successful ERCP, 14 patients had type I Bismuth Corlette (48.3%), 10 patients had type II (34.5%), 3 patients had type III (10.1%), and 2 patients had type IV (6.9%). Conclusion: PTD is superior to ERCP in drainage of hilar biliary obstruction. ERCP effectively drains Bismuth type I and II strictures, and no significant difference between using one plastic stent and two plastic stents in these types of strictures, while PTD is more effective in drainage of more complex strictures in Bismuth type III and IV.