Endoscopic ultrasound-guided gallbladder drainage for bilirubin normalization in distal malignant biliary...

Endoscopic transpapillary biliary drainage is currently recommended as the gold standard treatment modality for distal malignant biliary obstruction (DMBO) with endoscopic ultrasound (EUS)-guided biliary drainage being advocated in cases of endoscopic retrograde cholangiopancreatography failure. EUS-guided gallbladder drainage (GBD) has recently been proposed as a promising "rescue" and first-line alternative tool for managing DMBO. Indeed, high rates of both technical and clinical success along with a favorable safety profile have been reported. However, evidence regarding the capability of EUS-GBD to normalize total bilirubin in patients with DMBO is still lacking. Notably, bilirubin normalization is regarded as mandatory before starting chemotherapy, thus representing a crucial outcome of any biliary drainage method for DMBO. Our study aimed to summarize and discuss the current evidence concerning the effectiveness of EUS-GBD for bilirubin normalization in DMBO.