To the Editor The recent study by Inamdar et al1 suggested that endoscopic biliary drainage (EBD) is superior to percutaneous transhepatic biliary drainage (PTBD) in treating pancreatic cancer and cholangiocarcinoma because of its lower adverse event rate. Endoscopic biliary drainage is indeed the mainstay for treating benign and malignant biliary obstruction because of its less invasive nature; PTBD is generally used when EBD fails or is not available. The authors sought to avoid selection bias by excluding patients who underwent PTBD after failed EBD, patients with gallbladder cancer, and those with more than 1 kind of cancer leading to obstruction. However, this may have created bias in the reported complication rate for EBD because failed EBD may be associated with a higher complication rate than uncomplicated procedures. Endoscopic biliary drainage likely does have a lower complication rate in cases of pancreatic cancer and cholangiocarcinoma. However, in complex clinical scenarios, this may not be true. In previous research, PTBD provided better biliary drainage and had a lower complication rate than EBD in patients with hilar block and gallbladder carcinoma.2 A recent meta-analysis of malignant biliary tract obstruction cases demonstrated that PTBD is associated with a higher therapeutic success rate and lower incidence of cholangitis than EBD.3