Post written by Christina Gainey, MD, from the University of North Carolina, Chapel Hill, North Carolina, USA.

We wanted to study the feasibility, safety, and effectiveness of performing endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS)—guided gallbladder drainage (EUS-GBD) in a single session to provide definitive management of biliary obstruction and prevent future biliary adverse events without a patient ever needing to undergo surgery.

Surgical cholecystectomy after ERCP is the standard of care to treat biliary obstruction and prevent future gallstone-related disease. However, many patients are not surgical candidates, and delaying cholecystectomy is associated with recurrent biliary adverse events and mortality.

Although it is common practice to perform ERCP with placement of a cystic duct stent via endoscopic transpapillary gallbladder drainage if an ERCP is already being performed for another reason, this forgoes the significant advantages of EUS-GBD over endoscopic transpapillary gallbladder drainage (including higher success rates, lower recurrence rates, and shorter procedure times).

Our study is the first of its kind to be performed in the United States, to our knowledge. It shows that combining ERCP and EUS-GBD in a single session for nonsurgical patients is both effective and safe. Notably, no follow-up surgical cholecystectomy was necessary, highlighting the efficacy of EUS-GBD in managing gallbladder-related disease. More research with larger prospective cohorts is needed to confirm these findings and explore long-term outcomes.

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