S2191 Long-Term Outcomes After Endoscopic Ultrasound-Guided Gallbladder Drainage for Acute Cholecystitis and Malignant Biliary Obstruction: A Multicenter Study

Introduction: Endoscopic ultrasound-guided gallbladder drainage (EUS-GB) has emerged as a minimally invasive alternative for patients requiring decompression of the gallbladder, particularly in cases of acute cholecystitis or malignant distal biliary obstruction (MDBO) where traditional treatments may be high-risk or not possible. While short-term outcomes of EUS-GB are well documented, data on its long-term efficacy and safety remain limited. Additionally, it is unclear whether outcomes differ by indication, prompting a subgroup analysis comparing acute cholecystitis and MDBO patients. Methods: We conducted a retrospective analysis of patients who underwent EUS-GB at 2 US academic hospitals from 2015-2024. Primary outcomes included technical and clinical success, reintervention rate, and adverse events (AEs). Long-term follow-up data were reviewed to assess outcome durability. A subgroup analysis compared these outcomes between patients treated for acute cholecystitis and those treated for MDBO. Results: Seventy-seven patients were included, with 56 (72.7%) having acute cholecystitis and 21 (27.2%) with MDBO. The mean follow-up was 351 days. Technical and clinical success were 97.4% and 94.7%, respectively, with comparable rates between groups. Early and late AEs occurred in 5.3% and 8.0% of patients overall and were similar between acute cholecystitis and MDBO with early AEs (3.6% vs 10%, P = 0.288) and late AEs (16.4% vs 15%, P = 1). One-year reintervention rate was 9.3%, significantly higher in acute cholecystitis than MDBO (10.9% vs 5%, P = 0.014). The median time to reintervention for cholecystitis patients was 53 days. Conclusion: EUS-GB has high technical and clinical success with low AE rate. At a median follow-up of about one-year the overall reintervention rate is low for EUS-GB and is significantly higher in the cholecystitis subgroup compared to MDBO.