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41, 95% CI 0.30-0.57, p less then 0.00001), and total morbidity (OR = 0.34, 95% CI 0.23-0.50, p less then 0.00001) compared with patients who received internal drainage. Conclusions The current meta-analysis indicates that external drainage is better than internal drainage for malignant biliary obstruction in terms of the preoperative cholangitis rate, the incidence of stent dysfunction and total morbidity, etc. However, the findings need to be confirmed by randomized controlled trials.Introduction This meta-analysis was performed to c