Abstract: Objective To systematically evaluate the clinical effectiveness of ERCP and PTCD in treatment of malignant obstructive jaundice. Methods We searched databases including Pubmed, EMbase, the Cochrane libarary, CNKI, Wanfang databases and CBM from inception to May, 2018, both randomized controlled trials (RCTs) and controlled clinical trials (CCT) on comparing ERCP with PTCD in malignant obstructive jaundice were collected. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies. Stata 12.0 software was used to analyse the data. Results 9 eligible studies (2 RCTs and 7 CCTs) identified were finally included involving 994 persons. The results of meta-analysis showed that: The difference in the total successful rate of operation between the two groups was not statistically significant (OR = 0.88, 95%CI: 0.52 ~ 1.49, P = 0.631), which of the patients with low malignant obstructive jaundice in the ERCP group was significantly higher than that in the PTCD group (OR = 2.52, 95%CI: 1.26 ~ 5.04, P = 0.009), which of the patients with high malignant obstructive jaundice in the ERCP group was significantly lower than that in the PTCD group (OR = 0.17, 95%CI: 0.07 ~ 0.41, P = 0.000). The difference in the total effective rate between the two groups was not statistically significant (OR = 1.10, 95%CI: 0.75 ~ 1.62, P = 0.609), which of the patients with low malignant obstructive jaundice in the ERCP group was significantly higher than that in the PTCD group (OR = 5.80, 95%CI: 3.06 ~ 11.00, P = 0.000), which of the patients with high malignant obstructive jaundice in the ERCP group was significantly lower than that in the PTCD group (OR = 0.13, 95%CI: 0.07 ~ 0.24, P = 0.000). The incidence rate of complications of low obstruction in the ERCP group was obviously lower than that in the PTCD group (OR = 0.14, 95%CI: 0.06 ~ 0.32, P = 0.000), while there was no significant statistical difference between two groups both in the total incidence rate of complications (OR = 0.78, 95%CI: 0.39 ~ 1.57, P = 0.489) and the incidence rate of complications of high obstruction (OR = 1.35, 95%CI: 0.66 ~ 2.78, P = 0.414). Conclusion Satisfactory clinical effect for patients with malignant obstructive jaundice can be achieved from both ERCP and PTCD. The treatment of ERCP is more advantageous for patients with low obstruction, while PTCD is better than ERCP in patients with high obstruction.