Endoscopic Ultrasound-Guided Gallbladder Drainage as a Rescue Therapy for Unresectable Malignant Biliary Obstruction: A Multicenter Experience.

Background: ERCP is often unsuccessful in patients with duodenal stenosis or malignant ampullary infiltration. While EUS-guided biliary drainage (EUS-BD) has been proposed as an alternative, EUS-guided gallbladder drainage (EUS-GBD) is an attractive option when both approaches fail. We aimed to assess the effectiveness and safety of EUS-GBD as rescue therapy for malignant distal bile duct obstruction. Methods: A multicenter, retrospective study involving patients with unresectable malignant distal bile duct obstruction who underwent EUS-GBD between 2014-2019 after unsuccessful ERCP and EUS-BD. Clinical success was defined as a decrease in serum bilirubin of 50% within two weeks. Results: Twenty-eight patients were included. Lumen-apposing metal stent was used in 26 patients (93%), and self-expandable metal stent in 2(7%). Technical success rate was 100%. Clinical success rate was 92.6% with improvement in bilirubin (7.3±5.4 pre-procedure, vs. 2.8±1.1 post-procedure; P=0.001). Delayed adverse events included food impaction of the stent (n=3), 2 of which developed cholecystitis and bleeding. Conclusion: This study demonstrates the feasibility of gallbladder drainage to relieve malignant distal bile duct obstruction in patients with failed ERCP and EUS-BD.