Related Experiment Video
Updated: Jan 6, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Endoscopic Choledochoduodenostomy Versus Gallbladder Drainage for Malignant Biliary Obstruction: A Propensity Score
Noppachai Siranart1, Christopher C Thompson1,2, Marvin Ryou1,2
1Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Introduction:
Endoscopic ultrasound-guided gallbladder drainage (EUS-GB) is an emerging alternative to choledochoduodenostomy (EUS-CBD) for malignant distal biliary obstruction (MDBO), particularly when conventional access is not feasible.
Methods:
We conducted a multicenter, retrospective study of patients undergoing EUS-GB or EUS-CBD for MDBO between January 2015 and October 2024. Primary outcomes were technical and clinical success. Secondary outcomes included procedural time, 6-month reintervention, adverse events (AEs), and all-cause mortality. Propensity score matching (PSM) was used to adjust for baseline differences.
Results:
Eighty-two patients were included (22 EUS-GB, 60 EUS-CBD). Technical success was comparable between groups (95.5% vs. 96.7%). EUS-GB was used as salvage in 50% of cases when EUS-CBD was not feasible, with a 90.9% technical success rate. PSM yielded 21 matched pairs. After propensity score matching, clinical success was similar (95.2% EUS-GB vs. 85.7% EUS-CBD, p = 0.61). EUS-GB had significantly lower 6-month reintervention (4.8% vs. 23.8%, p = 0.004) and stent-related complications (0% vs. 18.9%). Adverse event rates and all-cause mortality were similar. Median follow-up was 116 days (IQR: 51-300). In the EUS-GB group, pre-procedural cystic duct patency predicted clinical success (94.1%).
Conclusion:
EUS-GB is a technically effective and clinically comparable alternative to EUS-CDS for MDBO, with significantly fewer reinterventions and stent-related complications. When cystic duct patency is confirmed on imaging, EUS-GB may be considered as a primary approach or salvage strategy for biliary drainage in MDBO.
