Endoscopic ultrasound-guided biliary drainage (EUS-BD) is being increasingly used as an alternate therapeutic modality to percutaneous transhepatic biliary drainage (PTBD) for biliary obstruction in patients who fail ERCP. We conducted a systematic review and meta-analysis to compare the efficacy and safety of these 2 procedures. We searched several databases from inception to September 4, 2016, to identify comparative studies evaluating the efficacy and safety of EUS-BD and PTBD. Primary outcomes of interest were the differences in technical success and postprocedure adverse events. Secondary outcomes of interest included clinical success, rate of reintervention, length of stay in hospital, and cost comparison for these 2 procedures. Odds ratios (OR) and standard mean difference were calculated for categorical and continuous variables respectively. These were analyzed using random effects model of meta-analysis.