Objective: To compare the clinical effects of three different procedures for palliative biliary drainage in malignant obstructive jaundice. Methods: The clinical data of 37 patients with malignant obstructive jaundice requiring palliative biliary drainage admitted from January 2007 to January 2012 were retrospectively analyzed. Of the patients, 14 cases underwent Roux-en-Y hepaticojejunostomy (conventional internal drainage group), 12 cases underwent modified loop-type biliary-enteric anastomosis (modified internal drainage group) and 11 cases underwent extracorporeal bile shunt (external drainage group). The jaundice reduction effects, intra- and postoperative parameters and survival status among the 3 groups were compared. Results: The postoperative total bilirubin level was significantly decreased in all the 3 groups compared with their preoperative levels, and the jaundice reduction effects of the 3 procedures were similar (P>0.05). The operative time, intraoperative blood loss, time to gastrointestinal function recovery and length of postoperative hospital stay in both modified internal drainage group and external drainage group were significantly reduced compared with conventional internal drainage group, and in external drainage group, the hospitalization cost was significantly lower than that in both conventional internal drainage group and modified internal drainage group and furthermore, the operative time and intraoperative blood loss were even less than those in modified internal drainage group (all P<0.05). Reflux cholangitis occurred in 2 cases (14.2%) in conventional internal drainage group in control group, but in none of the cases in either modified internal drainage group or external drainage group. There was no statistical difference in median postoperative survival among the 3 groups (P>0.05). Conclusion: Modified loop-type biliary-enteric anastomosis has demonstrable efficacy in treatment of malignant obstructive jaundice with quick recovery of organ functions, and can be considered as the first option for palliative biliary drainage. The extracorporeal bile shunt is a simple, minimally invasive procedure with less cost, so it is worthy to be applied in primary-level hospitals.