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Updated: Dec 28, 2025
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
EUS-guided versus endoscopic transpapillary gallbladder drainage in high-risk surgical patients with acute
Rajesh Krishnamoorthi1,2, Mahendran Jayaraj3, Viveksandeep Thoguluva Chandrasekar4
1Digestive Diseases Institute, Virginia Mason Medical Center, Seattle, WA, USA. Rajesh.Krishnamoorthi@virginiamason.org.
Insights
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) offers superior technical and clinical success rates compared to endoscopic transpapillary drainage (ET-GBD) for high-risk acute cholecystitis patients. EUS-GBD also reduces recurrent cholecystitis risk without increasing adverse events.
Area of Science:
- Gastroenterology
- Endoscopic Procedures
- Surgical Risk Management
Background:
- Percutaneous cholecystostomy (PC) is a traditional gallbladder drainage (GBD) method for high-risk acute cholecystitis patients.
- PC has limitations, leading to the exploration of endoscopic alternatives.
- Endoscopic GBD includes endoscopic transpapillary GBD (ET-GBD) and EUS-guided GBD (EUS-GBD).
Purpose of the Study:
- To systematically review and meta-analyze the effectiveness and safety of EUS-GBD compared to ET-GBD.
- To evaluate EUS-GBD as an alternative to PC for high-risk surgical patients with acute cholecystitis.
Main Methods:
- A systematic literature search was conducted through May 2019.
- Studies comparing EUS-GBD and ET-GBD for acute cholecystitis in high-risk patients were included.
- Pooled odds ratios for technical success, clinical success, and adverse events were calculated.
Main Results:
- EUS-GBD demonstrated significantly higher technical success (OR 5.22) and clinical success (OR 4.16) compared to ET-GBD.
- No significant difference in overall adverse events was observed between the two methods (OR 1.30).
- EUS-GBD was associated with a lower rate of recurrent cholecystitis (OR 0.33).
Conclusions:
- EUS-GBD is technically and clinically superior to ET-GBD for managing acute cholecystitis in select high-risk patients.
- EUS-GBD offers comparable safety to ET-GBD regarding adverse events.
- EUS-GBD is the preferred endoscopic approach due to its efficacy and reduced risk of recurrence.
Background:
In patients with acute cholecystitis who are deemed high risk for cholecystectomy, percutaneous cholecystostomy (PC) was historically performed for gallbladder drainage (GBD). There are several limitations associated with PC. Endoscopic GBD [Endoscopic transpapillary GBD (ET-GBD) and EUS-guided GBD (EUS-GBD)] is an alternative to PC. We performed a systematic review and meta-analysis to compare the effectiveness and safety of EUS-GBD versus ET-GBD.
Methods:
We performed a systematic search of multiple databases through May 2019 to identify studies that compared outcomes of EUS-GBD versus ET-GBD in the management of acute cholecystitis in high-risk surgical patients. Pooled odds ratios (OR) of technical success, clinical success and adverse events between EUS-GBD and ET-GBD groups were calculated.
Results:
Five studies with a total of 857 patients (EUS-GBD vs ET-GBD: 259 vs 598 patients) were included in the analysis. EUS-GBD was associated with higher technical [pooled OR 5.22 (95% CI 2.03-13.44; p = 0.0006; I2 = 20%)] and clinical success [pooled OR 4.16 (95% CI 2.00-8.66; p = 0.0001; I2 = 19%)] compared to ET-GBD. There was no statistically significant difference in the rate of overall adverse events [pooled OR 1.30 (95% CI 0.77-2.22; p = 0.33, I2 = 0%)]. EUS-GBD was associated with lower rate of recurrent cholecystitis [pooled OR 0.33 (95% CI 0.14-0.79; p = 0.01; I2 = 0%)]. There was low heterogeneity in the analyses.
Conclusion:
EUS-GBD has higher rate of technical and clinical success compared to ET-GBD. While the rates of overall adverse events are statistically similar, EUS-GBD has lower rate of recurrent cholecystitis. Hence, EUS-GBD is preferable to ET-GBD for endoscopic management of acute cholecystitis in select high-risk surgical patients.
