EUS-Guided Gallbladder Drainage Comparable to Choledochoduodenostomy in Small Cohort

A multicenter retrospective cohort study compared two endoscopic ultrasound-guided drainage approaches after failed ERCP in 60 patients with distal malignant biliary obstruction. Clinical success, adverse events and reintervention rates did not differ significantly between approaches.

Study included 60 patients at four Spanish centers.
Clinical success did not differ significantly between drainage approaches.
EUS-GBD may be a rescue option when EUS-CD is not feasible.
Small retrospective cohort limits comparisons between approaches.

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) may provide an alternative to choledochoduodenostomy (EUS-CD) for distal malignant biliary obstruction when ERCP fails. Investigators retrospectively reviewed consecutive patients treated with electrocautery-enhanced lumen-apposing metal stents at four tertiary centers in Spain. The primary endpoint was clinical success, defined as a 50% or greater bilirubin reduction within one week or bilirubin normalization within one month.

Among 60 patients, 35 received EUS-GBD and 25 EUS-CD. Clinical success was 74.3% with EUS-GBD and 88.0% with EUS-CD (p=0.33); technical success was 100% and 96.0%, respectively (p=0.40). Adverse events occurred in 37.2% and 20.0%, and reintervention in 28.6% and 12.0%, respectively; neither difference was statistically significant. Bilirubin trends, hospital stay and mortality also did not differ significantly. Seven patients treated with EUS-GBD later underwent pancreatoduodenectomy without LAMS-related complications.

The findings suggest EUS-GBD may be a feasible rescue option when EUS-CD is technically challenging or not possible. However, the small, retrospective study cannot establish equivalence, and the numerical differences in adverse events and reinterventions warrant cautious interpretation.

In practice

For patients with distal malignant biliary obstruction after failed ERCP, this small multicenter retrospective study suggests EUS-guided gallbladder drainage can be a feasible rescue option when choledochoduodenostomy is technically challenging or not possible. Clinical success and other measured outcomes did not differ significantly between procedures, but the study was not evidence of equivalence. The observed adverse-event and reintervention rates were numerically higher with EUS-GBD, so comparative safety remains uncertain; these findings alone do not establish a preferred approach.

AI-generated clinical interpretation · Not editor-reviewed

AI summary · Not yet editor-reviewed

Is this summary clinically accurate?

Help fellow clinicians: your rating sends inaccurate summaries straight to our editors.

Source

Surgical Endoscopy: Endoscopic ultrasound-guided gallbladder drainage versus choledochoduodenostomy for distal malignant biliary obstruction ↗

This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.