Post written by Saurabh Chandan, MD, from Houston Methodist West Hospital, Houston, Texas, and Douglas G. Adler, MD, FACG, AGAF, FASGE, from the Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Denver, Colorado, USA.

Interventional radiology techniques or EUS-guided biliary drainage are considered alternative therapeutic options for patients with malignant distal biliary obstruction (MDBO) who have failed ERCP or cannot undergo ERCP because of anatomical constraints. Although studies have demonstrated the feasibility of EUS-guided choledochoduodenostomy (EUS-CDS) with high efficacy, this technique may not be feasible in patients with a small common bile duct diameter or unsuitable duodenal wall thickness.

EUS-guided gallbladder drainage (EUS-GBD) has been proposed for patients with MDBO after EUS-CDS failure or for those with contraindications to EUS-guided biliary drainage. However, the published literature on this topic is sparse. We conducted a systematic review and meta-analysis comparing the safety and efficacy of EUD-CDS and EUS-GBD for palliation of MDBO.

Our analysis of 5 eligible studies (1 abstract and 4 full-text articles) including 352 patients (159 undergoing EUS-GBD and 193 undergoing EUS-CDS) revealed that EUS-GBD appears comparable with EUS-CDS in terms of technical and clinical success, adverse events, and stent dysfunction, provided cystic duct patency has been ascertained. It is important to highlight that our pooled analysis stems from a small number of retrospective studies performed at expert centers. Hence, our results may not be generalizable to routine clinical practice.

Although patient selection, anatomical factors, local expertise, and cystic duct patency remain important considerations in palliation of MDBO, further prospective studies comparing outcomes of EUS-CDS and EUS-GBD are warranted.

A, Clinical success of EUS-guided gallbladder drainage (EUS-GBD). B, Clinical success of EUS-guided choledochoduodenostomy (EUS-CDS). C, Clinical success of EUS-GBD versus EUS-CDS.

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