EUS-Guided Gallbladder Drainage: GIE | October 2026

What Did the Study Find?

This meta-analysis compared EUS-guided choledochoduodenostomy (EUS-CDS) with EUS-guided gallbladder drainage (EUS-GBD) for palliation of malignant distal biliary obstruction when ERCP fails or is not feasible.

• 352 patients were included: 193 underwent EUS-CDS, and 159 underwent EUS-GBD.
• Technical success was comparable: 93.3% with EUS-CDS versus 95.9% with EUS-GBD.
• Clinical success was similarly high: 90.1% versus 86.6%, respectively.
• Overall adverse events: 19.7% versus 17.6%, without a significant difference.
• Severe adverse events: 11.0% versus 8.3%, also without a significant difference.
• Stent dysfunction rates were nearly identical: 15.0% versus 14.5%.
• None of the assessed comparative outcomes demonstrated a statistically significant difference between the two approaches.

Why Does It Matter?

EUS-CDS provides direct biliary drainage, whereas EUS-GBD offers an alternative route through the gallbladder when conventional biliary access is difficult.

These findings suggest that EUS-GBD may provide effective palliation in selected patients, potentially expanding endoscopic drainage options after unsuccessful ERCP.

However, EUS-GBD requires a patent cystic duct and adequate communication with the obstructed biliary system to achieve effective biliary decompression.

GastroAGI Takeaway

When ERCP fails in malignant distal biliary obstruction, EUS-guided gallbladder drainage deserves consideration—not just direct bile duct drainage.

This meta-analysis found similar technical success, clinical effectiveness, adverse events and stent dysfunction between EUS-GBD and EUS-CDS.

The practical implication is that EUS-GBD can be considered an alternative rescue drainage strategy in appropriately selected patients, particularly when EUS-CDS is technically challenging or unsuitable.