Endoscopic ultrasound-guided gallbladder drainage versus choledochoduodenostomy for distal malignant biliary...

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged as a potential alternative to endoscopic ultrasound-guided choledochoduodenostomy (EUS-CD) for distal malignant biliary obstruction (DMBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). Comparative evidence remains scarce.

We performed a multicenter retrospective cohort study including consecutive patients who underwent EUS-GBD or EUS-CD using electrocautery-enhanced lumen-apposing metal stents after failed ERCP at four Spanish tertiary centers. The primary outcome was clinical success, defined as a ≥50% reduction in serum bilirubin within one week or normalization (< 2 mg/dL) within one month. Secondary outcomes included technical success, adverse events, endoscopic reintervention, hospital stay, and mortality.

Sixty patients were included, with 35 undergoing EUS-GBD and 25 EUS-CD. Baseline characteristics were comparable except for older age in the EUS-CD group (79.8 vs. 71.7 years; p = 0.01). Clinical success was achieved in 74.3% and 88.0% of patients, respectively (p = 0.33), while technical success was 100% and 96.0% (p = 0.40). Bilirubin reduction at 24 h, 48 h, 7, 14, and 30 days and median hospital stay were similar. Adverse events occurred in 20.0% in the EUS-CD group and 37.2% of patients in the EUS-GBD group (p = 0.25), and reintervention rates were 12.0%, and 28.6%, respectively (p = 0.20). Thirty-day mortality and overall survival did not differ significantly. Seven patients undergoing EUS-GBD subsequently underwent pancreatoduodenectomy without complications related to LAMS.

In selected patients with DMBO after failed ERCP, EUS-GBD provides efficacy and safety comparable to EUS-CD and represents a feasible rescue option when choledochoduodenostomy is technically challenging or not feasible.