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PTBD under LA

Percutaneous Transhepatic Biliary Drainage often takes the recommendation second to ERCP. Nevertheless, a trained- skilled IR can easily argue as to why PTBD is far easier and superior to the ERCP procedure. It can be understood from the fact very that, as the malignant obstruction involves higher and higher biliary confluences it is often more advanced and it is more difficult for the ERCP and the recommendation shifts to the PTBD by an IR. Also as the obstruction is lower and closer to ampulla , it becomes easier for PTBD by an IR but it is done by ERCP by endoscopist. Now this is clearly ironical and it contradicts the logic.