198 EUS-Guided Gallbladder Drainage in High-Risk and Rescue Scenarios: Evaluating Safety and Feasibility for UK Integration

Abstract Aim Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is increasingly recognised internationally as a safe, minimally invasive alternative for patients unfit for emergency cholecystectomy. It also offers value as a rescue option following failed biliary drainage. Despite growing use abroad, no standardised pathway currently exists in the UK. This study evaluates the feasibility and safety of EUS-GBD in both primary and rescue settings. Method A retrospective review was conducted of 15 patients who underwent EUS-GBD at a UK tertiary centre. Nine acutely unwell patients were deemed unfit for surgery and received EUS-GBD as primary management. Six underwent the procedure as a rescue intervention after failed common bile duct stenting. All were referred after consultant-led multidisciplinary review. Demographics, indications, procedural details, outcomes, and complications were analysed. Results Technical and clinical success was achieved in all 15 cases (100%). Median age in the primary group was 80 years (44.4% female), and 77 years (33.3% female) in the rescue group. Lumen-apposing metal stents were used in all cases. No complications related to the procedure were observed (0/15), either immediately or during follow-up. These findings demonstrate consistent success across both groups, supporting the safety and feasibility of EUS-GBD in a UK setting. A draft clinical outline and supporting procedural video were included to aid future integration into routine care. Conclusions EUS-GBD is a safe and effective option for gallbladder drainage in surgically unfit and rescue cases. These findings support broader consideration and future integration into UK practice.