Endoscopy
DOI: 10.1055/a-2650-5492
Original article

Endoscopic ultrasound-guided gallbladder versus bile duct drainage for first-line therapy of malignant biliary obstruction: international multicenter trial

 1   Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy
 2   Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital – IRCCS, Rozzano, Italy
,
Daryl Ramai
 3   Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, United States
,
 2   Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital – IRCCS, Rozzano, Italy
,
 2   Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital – IRCCS, Rozzano, Italy
 4   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
,
Marco Spadaccini
 2   Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital – IRCCS, Rozzano, Italy
 4   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
,
Carmelo Barbera
 5   Gastroenterology and Endoscopy Unit, Ospedale G. Mazzini, Teramo, Italy
,
 6   Pancreatobiliary Endoscopy and EUS division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
,
 7   Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense, Garbagnate Milanese, Milan, Italy
,
 8   Endoscopy Unit, Department of Digestive Diseases, Hospital General Universitario de Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
,
Roberto Di Mitri
 9   Gastroenterology and Endoscopy Unit, ARNAS Civico – Di Cristina – Benfratelli Hospital, Palermo, Italy
,
Francesco Di Matteo
10   Therapeutic GI Endoscopy Unit, Campus Bio-Medico University Hospital, Rome, Italy
,
Alberto Larghi
11   Digestive Endoscopy Unit, Universita’ Cattolica del Sacro Cuore, Rome, Italy
,
12   Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, University Hospital Omni, Guayaquil, Ecuador
,
Andrea Anderloni
13   Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
,
14   Unit of Gastroenterology and Digestive Endoscopy, ASST Santi Paolo e Carlo, Milan, Italy
,
15   Surgery, Prince of Wales Hospital, Hong Kong, Hong Kong
,
16   Gastroenterology Department, Enrique Baltodano Briceno Hospital, Liberia, Costa Rica
,
Edoardo Forti
17   Digestive Endoscopy, Ospedale Niguarda-Ca’ Granda, Milan, Italy
,
18   Gastroenterology and Hepatology, KU Leuven University Hospitals Leuven, Leuven, Belgium
,
Helga Bertani
19   Gastroenterologia ed Endoscopia Digestiva Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
,
20   Medical Gastroenterology, AIG Hospitals, Hyderabad, India
,
21   Medicine, Haukeland University Hospital, Bergen, Norway
,
Stefano Francesco Crinò
22   Gastroenterology, University of Verona, Verona, Italy
,
Alessandro Repici
 2   Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital – IRCCS, Rozzano, Italy
 4   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
,
23   Department of Experimental Medicine, Section of Gastroenterology, University of Salento, Lecce, Italy
,
Biliary Therapeutic EUS Study Group
› Author Affiliations
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Abstract

Background Endoscopic ultrasound (EUS)-guided gallbladder drainage (GBD) and EUS-guided choledochoduodenostomy (CDS) with lumen-apposing metal stents are alternative approaches to endoscopic retrograde cholangiopancreatography. We compared EUS-GBD and EUS-CDS as first-line therapies in the management of distal malignant biliary obstruction (MBO).

Methods This was an international, multicenter, retrospective, observational study at 28 tertiary care centers from April 2017 to August 2024. Outcomes were compared using propensity score matching. The primary outcome was clinical success. Secondary outcomes included technical success, adverse events, and overall survival.

Results 291 patients (mean age 74 [SD 12] years; 130 male) underwent EUS-guided drainage (82 EUS-GBD, 209 EUS-CDS). Most patients developed distal MBO from pancreatic cancer (84 %). After 1-to-1 propensity score matching, 154 patients were selected (77 per group). EUS-GBD and EUS-CDS had similar rates of technical success (96 % [95 %CI 89 %–99 %] vs. 99 % [95 %CI 92 %–99 %]; P = 0.36) and clinical success (86 % [95 %CI 75 %–92 %] vs. 92 % [95 %CI 83 %–97 %]; P = 0.17), respectively. Overall, 11 patients (14.2 % [95 %CI 7 %–24 %]) in each group experienced an adverse event, of which 6 in each group (8 % [95 %CI 2 %–16 %]) were serious.

Conclusion Our study showed that in patients with distal MBO, the use of EUS-GBD or EUS-CDS were comparable, with similar rates of efficacy and safety. EUS-GBD could represent an easy and safe option in patients with DMBO without previous cholecystectomy and with clear patency of the cystic duct.

Supplementary Material



Publication History

Received: 10 December 2024

Accepted after revision: 23 June 2025

Article published online:
22 July 2025

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