ArticleSurgical endoscopy2026
Endoscopic ultrasound-guided gallbladder drainage versus choledochoduodenostomy for distal malignant biliary obstruction.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEndoscopic 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.
methodsWe 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.
resultsSixty 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.
conclusionsIn 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.
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