Transgastric versus transduodenal endoscopic ultrasound-guided gallbladder drainage: an observational study

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with lumen-apposing metal stents (LAMS) is an effective strategy for high-risk surgical patients. The optimal access route-transgastric (TG) versus transduodenal (TD)-remains uncertain. We compared outcomes of TG versus TD EUS-GBD at a high-volume tertiary center.

We included patients who underwent EUS-GBD between January 2020 and December 2024. Baseline demographics, clinical variables, and outcomes data were collected. The primary outcome was clinical success, defined as resolution of cholecystitis or relief of biliary obstruction. Secondary outcomes included stent misdeployment, adverse events (AEs), and need for endoscopic reintervention. Comparisons were performed using the unpaired T-test, Mann-Whitney U test, and Fisher's exact test, with significance at p < 0.05.

We included 82 patients (mean age 72 years, 48% female). The indication for drainage was cholecystitis for 45 (55%) patients and MDBO with a patent cystic duct and prior failed ERCP for 37 (45%) patients. Sixty-four (78%) patients underwent transduodenal (TD) EUS-GBD and 18 (22%) underwent transgastric (TG) EUS-GBD. There was no difference between the two groups for clinical success (TD 89% vs. TG 94%, p = 0.68) overall nor when evaluated by procedural indication. There were five (8%) cases of stent misdeployment in the TD EUS-GBD group and zero cases in the TG EUS-GBD group (p = 0.58), all of which were salvaged endoscopically. There were no significant differences between groups for AEs (20% vs. 17%, p =  > 0.99) or unplanned endoscopic reintervention (16% vs. 11%, p =  > 0.99).

Both TG and TD EUS-GBD are effective and relatively safe, supporting an individualized approach based on technical feasibility and future surgical candidacy. A potential trend toward more misdeployments in the TD EUS-GBD group warrants further study.