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Updated: Mar 15, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Percutaneous transhepatic versus EUS-guided gallbladder drainage for malignant cystic duct obstruction
Jin Ho Choi1, Hyoung Woo Kim2, Jong-Chan Lee2
1Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
Insights
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) offers a safe and effective alternative to percutaneous transhepatic gallbladder drainage (PTGBD) for managing malignant cystic duct obstruction, improving quality of life in non-surgical candidates.
Area of Science:
- Gastroenterology
- Interventional Endoscopy
- Oncology
Background:
- Malignant cystic duct obstruction can cause acute cholecystitis or gallbladder hydrops.
- Surgery is often not an option for these patients.
- Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an emerging palliative treatment.
Purpose of the Study:
- To compare the efficacy and safety of EUS-GBD with percutaneous transhepatic gallbladder drainage (PTGBD).
- To evaluate EUS-GBD as a palliative management strategy for malignant cystic duct obstruction.
Main Methods:
- Retrospective review of 14 patients treated with EUS-GBD (covered metal stents).
- Comparison with 19 patients treated with PTGBD for similar conditions.
- Analysis of technical success, clinical success, adverse events, and stent patency.
Main Results:
- EUS-GBD achieved technical success in 85.7% and clinical success in 91.7%.
- PTGBD had 100% technical success and 86.4% clinical success.
- Adverse event rates were similar (28.5% for EUS-GBD, 21.1% for PTGBD).
- EUS-GBD demonstrated longer stent patency without need for re-intervention before death.
Conclusions:
- EUS-GBD is a feasible, safe, and effective treatment for malignant cystic duct obstruction in non-surgical patients.
- EUS-GBD can improve the long-term quality of life for patients with advanced cancer.
Background And Aims:
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has been proposed as an alternative management strategy for acute cholecystitis caused by malignant cystic duct obstruction in patients for whom surgery is not an option. This study aimed to compare the results of EUS-GBD with those of percutaneous transhepatic gallbladder drainage (PTGBD) for palliative management of malignant cystic duct obstruction with acute cholecystitis or symptomatic gallbladder hydrops.
Methods:
Between November 2013 and November 2015, 14 patients with acute cholecystitis or symptomatic gallbladder hydrops as a result of malignant cystic duct obstruction underwent EUS-GBD with covered metal stents. Nineteen patients with acute cholecystitis as a result of malignant cystic duct obstruction who received PTGBD served as a control group. Patients' medical records were reviewed retrospectively.
Results:
The technical and clinical success rates of EUS-GBD were 85.7% (12/14) and 91.7% (11/12) and of PTGBD were 100% (19/19) and 86.4% (17/19), respectively. The groups had similar adverse event rates (28.5% and 21.1%, respectively). The average duration of stent patency in patients with EUS-GBD was 130.3 ± 35.3 days, and no patient required an additional procedure before death. In 6 of 17 patients (35.3%) with clinically successful PTGBD, the catheter was not removed until the end stage of life.
Conclusions:
EUS-GBD is a feasible, safe, and effective modality for the treatment of malignant cystic duct obstruction in patients who are not indicated for surgery. It enables improved long-term quality of life in patients with advanced-stage cancer.
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