Abstract: Objective To compare the clinical efficacy of endoscopic retrograde cholangiopancreatography(ERCP)with biliary stent implantation and real-time ultrasound-guided percutaneous transhepatic biliary drainage(PTCD)in the treatment of malignant obstructive jaundice. Methods A total of 96 patients with malignant obstructive jaundice in the First Affiliated Hospital of Jinzhou Medical University were selected and divided into ERCP group(n=52)and PTCD group(n=44). The success rate of operation, clinical efficiency, biochemical indexes and complications were compared between the two groups. Results The success rate of operation in ERCP group was 80.77%, which was significantly lower than 95.45% in PTCD group(P<0.05). The success rate of operation for high-position obstruction in ERCP group was 75.86%, which was significantly lower than 96.00% in PTCD group(P<0.05). The clinical effective rate of low-position obstruction in ERCP group was 100.00%, which was significantly higher than 77.78% in PTCD group(P<0.05). The clinical effective rate of high-position obstruction in ERCP group was 72.73%, which was significantly lower than 95.83% in PTCD group(P<0.05). There were no significant differences in clinical indexes at 5 days after operation between two groups(P>0.05). The incidence rates of acute pancreatitis, biliary tract infection and total complications in ERCP group were significantly higher than those in PTCD group(P<0.05). Conclusion Both PTCD and ERCP have their own advantages. In clinical practice, it is suggested to select PTCD or ERCP according to the position of obstruction, the purpose of drainage and the experience level of biliary drainage.-