Post written by Cecilia Binda, MD, from the Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy.

Our study focused on EUS-guided gallbladder drainage (EUS-GBD) as an option for jaundice treatment that may be reserved for patients affected by distal malignant biliary obstruction (DMBO) after ERCP failure and EUS-guided biliary drainage (hepaticogastrostomy or choledochoduodenostomy) failure because of multiple reasons (such as <15 mm or altered anatomy).

This technique is grounded on the possibility of the bile flowing from the intrahepatic ducts and the common bile duct in the gallbladder through the cystic duct.

The aim of the study was to evaluate the outcome of patients with DMBO who underwent EUS-GBD with lumen-apposing metal stents (LAMSs) performed as a rescue treatment in 14 Italian centers from June 2015 to June 2020.

There are still few data on this technique. Indeed, evidence comes from at least case reports or small series of patients and using both LAMSs and self-expandable metal stents.

To the best of our knowledge, this represents the largest study on this technique using LAMSs, showing how this is a safe and effective technique for patients with DMBO when other techniques fail. Drainage was technically successful in all patients while clinical success was approximately 81%.

Regardless the route of drainage (transgastric or transduodenally), the decrease in bilirubin levels within 15 days was satisfying, ≤66% from baseline, and at least comparable with those shown using EUS-guided choledochoduodenostomy. The rate of adverse events was acceptable (approximately 10%), and they were mainly mild or moderate in severity.

However, studies are needed to assess long-term outcomes, comparing this technique with other EUS-guided biliary drainages and determining if this technique could be a valuable option even as a bridge to surgery.

Thank you to Drs Ilaria Tarantino, Andrea Anderloni, and Carlo Fabbri and all the i-EUS group for the collaboration and effort for such an achievement.

Graphical Abstract

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