Endoscopy 2025; 57(S 02): S75-S76
DOI: 10.1055/s-0045-1805241
Abstracts | ESGE Days 2025
Oral presentation
Biliary access and beyond! 04/04/2025, 08:30 – 09:30 Room 118+119

Endoscopic Ultrasound (EUS)-Guided Gallbladder Drainage vs EUS-Guided Bile Duct Drainage for First Line Therapy of Malignant Biliary Obstruction: An International Multicenter Study

M Benedetto
1   Humanitas Mater Domini, Castellanza, Italy
,
D Paduano
1   Humanitas Mater Domini, Castellanza, Italy
,
D Ramai
2   Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, United States of America
,
G franchellucci
3   Humanitas Research Hospital,Department of Gastroenterology and Hepatology, Rozzano, Italy
,
C Barbera
4   Gastroenterologia ed Endoscopia – Ospedale Teramo, Teramo, Italy
,
F Frigo
5   Ospedale San Giovanni Bosco, Torino, Italy
,
A Fugazza
6   Gastroenterology and Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Italy
,
G De Nucci
7   Garbagnate Milanese Hospital, Milan, Italy
,
G Vanella
8   IRCCS San Raffaele Scientific Institute, Milan, Italy
,
C Ko
9   Health University Of Utah, Salt Lake City, United States of America
,
D M Francesco
10   Campus biomedico University Hospital, Roma, Italy
,
A Larghi
11   Agostino Gemelli University Policlinic, Rome, Italy
,
A Anderloni
12   Fondazione I.R.C.C.S. Policlinico San Matteo, Gastroenterology and Digestive Endoscopy Unit, Pavia, Italy
,
F Auriemma
1   Humanitas Mater Domini, Castellanza, Italy
,
F Minini
6   Gastroenterology and Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Italy
,
P Arcidiacono
13   Vita-Salute San Raffaele University, Milano, Italy
,
C Gentile
1   Humanitas Mater Domini, Castellanza, Italy
,
C Federica
14   Humanitas ma, castellanza, Italy
,
L L De
15   Endoscopic Unit, ASST Santi Paolo e Carlo, Milan, Italy
,
A Y Teoh
16   Prince of Wales Hospital, Hong Kong, Hong Kong
,
C Gallo
17   ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
,
E Forti
18   Digestive Endoscopy Unit, Ospedale Niguarda, Milano, Italy
,
M Mutignani
19   ASST Great Metropolitan Niguarda, Milano, Italy
,
M Santi
20   Azienda Ospedaliero – Universitaria di Modena, Modena, Italy
,
H Bertani
21   Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
,
G Aragona
22   Gastroenterology and Hepatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
,
E Troncone
23   Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
,
G Del Vecchio Blanco
23   Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
,
KD C Pham
24   Haukeland University Hospital / Health Bergen, Bergen, Norway
,
V G Mirante
25   AUSL Reggio Emilia, Reggio Emilia, Italy
,
S F Crinò
26   University of Verona, Via San Francesco, Verona, VR, Italy, Italy
,
E Aljahdli
27   King Abdulaziz University Hospital, Jeddah, Saudi Arabia
,
S Sundaram
28   TATA MEMORIAL HOSPITAL, Parel, Mumbai, Mumbai, India
,
A Al-Lehibi
29   King Saud Bin Abduaziz University-Health Science, King Fahad Medical City, Riyadh, Saudi Arabia
,
A Alfadda
30   Riyadh, Riyadh, Saudi Arabia
,
M Fiacca
31   Humanitas Research Hospital, Milan, Italy
,
G Manes
32   Gastroenterology Unit, Rho-Garbagnate Hospital, ASST Rhodense, Milan, Italy
,
F Decembrino
33   Ente Ecclesiastico-Ospedale Generale Regionale, bar, Italy
,
G Fierro
34   Rho Hospital, Rho, Italy
,
G Manes
34   Rho Hospital, Rho, Italy
,
J D Morris
9   Health University Of Utah, Salt Lake City, United States of America
,
B Martínez
35   Hospital General Universitario, alican, Spain
,
J R Aparicio
36   General University Hospital of Alicante, Alacant, Spain
,
S Stigliano
37   Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
,
M Bronswijk
38   Imeldaziekenhuis, Bonheiden, Belgium
,
S Van der Merwe
39   University Hospital Gasthuisberg, Leuven, Belgium
,
S Lakhtakia
40   Asian Institute of Gastroenterology, Hyderabad, India
,
A Ventra
41   Azienda Ospedaliera Grande Ospedale Metropolitano Bianchi, Reggio Calabria, Italy
,
A Repici
42   Humanitas Research Hospital, Rozzano, Italy
,
A Facciorusso
43   Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
› Author Affiliations
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Aims Endoscopic ultrasound (EUS)–guided gallbladder (GB) drainage and EUS-guided bile duct (BD) drainage with lumen-apposing metal stents are alternative approaches to endoscopic retrograde cholangiopancreatography (ERCP). We compared EUS-GB and EUS-BD as first line therapies in the management of malignant biliary obstruction (MBO) [1] [2] [3].

Methods This was an international multicenter retrospective observational study at 28 tertiary-care centers through August 2024. Consecutive patients with MBO who underwent EUS-GB or EUS-BD as first line therapy with LAMS placement were included. Outcomes were compared using propensity score matching. Cohorts were compared using Chi-square, Mann-Whitney tests, and logistic regression.

Results Two hundred and ninety-one patients (130 males; average age 74±12 years) underwent EUS guided drainage where 82 patients underwent EUS GB drainage, and 209 patients underwent EUS BD drainage. Most patients developed MBO from pancreatic cancer (79%). AXIOS stents were used in most cases (n=270) compared to SPAXUS (n=21). Overall, technical success was reported in 96% of cases and clinical success in 88% of cases. After 1-to-1 propensity score matching, 154 patients were selected (77 per group). EUS-GB and EUS-BD had similar technical success rates (96% vs 99%, P=0.311) and clinical success rates (86% vs 92%, P=0.199). No statistical differences were reported in adverse events including bleeding (P=1.000), perforation (P=0.316), stent occlusion (P=0.649), stent migration (P=0.173), and acute pancreatitis (P=0.080). Stent type was not associated with technical success (AXIOS 90% vs SPAXUS 75%, P=0.332) or clinical success (AXIOS 91% vs 82%, P=0.298). On univariate analysis, the type of EUS drainage procedure was not a significant predictor of technical success (P=0.335) or clinical success (P=0.205).

Conclusions Our study showed that in patients with MBO, the use of EUS-guided GB or EUS-guided BD were comparable with similar rates of efficacy and safety. These findings provide evidence for greater adoption of EUS-GB and EUS-BD in clinical practice as therapeutic alternatives to ERCP in patients with MBO.



Publication History

Article published online:
27 March 2025

© 2025. European Society of Gastrointestinal Endoscopy. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Mangiavillano B, Moon JH, Facciorusso A, Vargas-Madrigal J, Di Matteo F, Rizzatti G, De Luca L, Forti E, Mutignani M, Al-Lehibi A, Paduano D, Bulajic M, Decembrino F, Auriemma F, Franchellucci G, De Marco A, Gentile C, Shin IS, Rea R, Massidda M, Calabrese F, Mirante VG, Ofosu A, Crinò SF, Hassan C, Repici A, Larghi A.. Endoscopic ultrasound-guided gallbladder drainage as a first approach for jaundice palliation in unresectable malignant distal biliary obstruction: Prospective study. Dig Endosc 2024; 36 (03): 351-358 Epub 2023 Jul 3. PMID: 37253185
    CrossrefPubMedSearch in Google Scholar
  • 2 Paduano D, Facciorusso A, De Marco A, Ofosu A, Auriemma F, Calabrese F, Tarantino I, Franchellucci G, Lisotti A, Fusaroli P, Repici A, Mangiavillano B.. Endoscopic Ultrasound Guided Biliary Drainage in Malignant Distal Biliary Obstruction. Cancers (Basel) 2023; 15 (02): 490 PMID: 36672438; PMCID: PMC9856645
    CrossrefPubMedSearch in Google Scholar
  • 3 Facciorusso A, Mangiavillano B, Paduano D, Binda C, Crinò SF, Gkolfakis P, Ramai D, Fugazza A, Tarantino I, Lisotti A, Fusaroli P, Fabbri C, Anderloni A.. Methods for Drainage of Distal Malignant Biliary Obstruction after ERCP Failure: A Systematic Review and Network Meta-Analysis. Cancers (Basel) 2022; 14 (13): 3291 PMID: 35805062; PMCID: PMC9266204
    CrossrefPubMedSearch in Google Scholar