Predictors of Biliary Drainage Dysfunction Following EUS-Guided Gallbladder Drainage for Malignant Distal Biliary...

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Oncology

Background:

• Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is a key treatment for malignant distal biliary obstruction.
• Predictors of EUS-GBD dysfunction, success, and morbidity are not well-defined.

Purpose of the Study:

• To identify clinical and procedural factors influencing EUS-GBD dysfunction.
• To determine predictors of clinical success and high-grade adverse events.

Main Methods:

• Retrospective, international, multicenter cohort study (March 2017-September 2024).
• 166 patients with malignant distal biliary obstruction undergoing EUS-GBD with lumen-apposing metal stents.
• Analysis of biliary drainage dysfunction, clinical success, and adverse events using Kaplan-Meier and Cox regression.

Main Results:

• High technical (98.8%) and clinical (82.9%) success rates were observed.
• 12-month biliary patency was 70.4%; neither access route nor stent diameter affected patency.
• Ascites was the sole independent predictor of dysfunction (HR 2.45). Cystic duct patency predicted clinical success (OR 2.88). 15-mm stents showed reduced high-grade adverse events (OR 0.31).

Conclusions:

• Ascites is the primary predictor of EUS-GBD dysfunction in malignant biliary obstruction.
• 15-mm stents may offer a safety benefit regarding high-grade morbidity.
• Prospective studies are needed to confirm the role of larger stents in reducing adverse events.