Endoscopic ultrasound-guided gallbladder drainage for distal malignant biliary obstruction: Outcomes from a multicenter cohort.

Background and study aims: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is described as salvage therapy for patients with distal malignant biliary obstruction (DMBO). However, there is a paucity of data reporting on clinical outcomes for this indication. Patients and methods: A multicenter retrospective review of 26 EUS-GBD cases was performed between 2017 and 2023 at two centers in New Zealand. Efficacy outcomes of technical success (TS), clinical success (CS), length of stay (LOS), and resumption of cancer therapy were recorded. Adverse events (AEs), reinterventions, time to reintervention, and survival also were examined. Reinterventions were categorized into early (< 7 days) or delayed procedures (≥ 7 days). Results: Mean age was 74 years. Pancreatic cancer was the most common diagnosis. All included cases were unresectable and eight of 26 (30.8%) were chemotherapy candidates. TS and CS were achieved in all patients. At 14 days, bilirubin decreased from a mean of 139 to 55 μmol/L, a 60.4% reduction from baseline value. Mean LOS was 3 days. Of eligible patients, 87.5% were able to resume chemotherapy post-procedure. There were no intra-procedural complications nor early reinterventions. Four serious AEs (15.4%) required reintervention; the remaining nine were treated conservatively. Median survival was 103 days. Conclusions: EUS-GBD is a clinically effective salvage therapy for DMBO that may be positioned after unsuccessful endoscopic retrograde cholangiopancreatography or EUS-BD in a single anesthetic session. Most patients have a short LOS and few serious AEs. Furthermore, oncologic therapy can be successfully resumed post-procedure. EUS-GBD, therefore, should be considered an effective, safe, and durable addition to the treatment armamentarium for DMBO.