Management of <scp>ERCP</scp> Failure in Malignant Biliary Obstruction: Comparative Effectiveness and Safety of <scp>EUS</scp> ‐Guided Gallbladder Drainage Versus Choledocoduodenostomy

OBJECTIVES: It is unclear which is the best approach for the drainage of malignant distal biliary obstruction (MDBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). We compared endoscopic ultrasound (EUS)-guided gallbladder drainage (GBD) and EUS-guided choledocoduodenostomy (CDS) with lumen-apposing metal stents (LAMS) as rescue treatment in the case of ERCP failure. METHODS: This was an international multicenter retrospective observational study at 28 tertiary-care centers. Outcomes were compared using propensity score matching (PSM). Clinical success was the primary outcome, with technical success, adverse event (AE) rate, and overall survival being the secondary outcomes. RESULTS: Five hundred twenty-nine patients underwent EUS-guided drainage, of which 136 underwent EUS-GBD, and 393 underwent EUS-CDS. After 1-to-1 PSM, 112 patients per group were selected. EUS-GBD and EUS-CDS had similar technical success (97.3% and 91%; p = 0.08) and clinical success rates (83% and 85.7%; p = 0.17). AE rate was 19.6% in the EUS-GBD group and 12.5% in the EUS-CDS group (p = 0.20), of which 10 (8.9%) and 7 (6.2%) were severe AEs respectively (p = 0.61). Bleeding occurred in seven patients (6.1%) after EUS-GBD and three patients (2.5%) after EUS-CDS, whereas five infectious events were registered after EUS-GBD (4.4%) and four cases (3.5%) after EUS-CDS (p = 0.29). No treatment-related deaths were observed. CONCLUSION: In patients with MDBO after failed ERCP, EUS-GBD or EUS-CDS were comparable with similar rates of efficacy and safety. EUS-GBD could represent an easy and safe option in MDBO patients without previous cholecystectomy and with a clear patency of the cystic duct.

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Journal
Digestive Endoscopy
Published
2026-04-01
DOI
https://doi.org/10.1111/den.70145
Primary Topic
Gallbladder and Bile Duct Disorders
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article
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article

Management of ERCP Failure in Malignant Biliary Obstruction: Comparative Effectiveness and Safety of EUS ‐Guided Gallbladder Drainage Versus Choledocoduodenostomy

Edoardo Forti, Stefano Francesco Crinò, Andrew K. Fuller, Luca De Luca et al.
Digestive Endoscopy
Gallbladder and Bile Duct Disorders
article

Management of ERCP Failure in Malignant Biliary Obstruction: Comparative Effectiveness and Safety of EUS ‐Guided Gallbladder Drainage Versus Choledocoduodenostomy

Edoardo Forti, Stefano Francesco Crinò, Andrew K. Fuller, Luca De Luca, Anthony Yuen Bun Teoh, Andrea A. Anderloni, Helga Bertani, Santi Mangiafico, Giuseppe Vanella, Gianluca Franchellucci, Benedetto Mangiavillano, Carlos Robles‐Medranda, Germana de Nucci, Marco Spadaccini, Michiel Bronswijk, Francesco Auriemma, Khanh Do‐Cong Pham, Belén Martínez‐Moreno, Alessandro Fugazza, Antonio Facciorusso, Sundeep Lakhtakia, EUS International Group, Carmelo Barbera, Alessandro Repici, Daryl Ramai, Francesco Di Matteo, Roberto Di Mitri, Sridhar Sundaram, Jorge Vargas‐Madrigal
article en

Abstract

OBJECTIVES: It is unclear which is the best approach for the drainage of malignant distal biliary obstruction (MDBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). We compared endoscopic ultrasound (EUS)-guided gallbladder drainage (GBD) and EUS-guided choledocoduodenostomy (CDS) with lumen-apposing metal stents (LAMS) as rescue treatment in the case of ERCP failure. METHODS: This was an international multicenter retrospective observational study at 28 tertiary-care centers. Outcomes were compared using propensity score matching (PSM). Clinical success was the primary outcome, with technical success, adverse event (AE) rate, and overall survival being the secondary outcomes. RESULTS: Five hundred twenty-nine patients underwent EUS-guided drainage, of which 136 underwent EUS-GBD, and 393 underwent EUS-CDS. After 1-to-1 PSM, 112 patients per group were selected. EUS-GBD and EUS-CDS had similar technical success (97.3% and 91%; p = 0.08) and clinical success rates (83% and 85.7%; p = 0.17). AE rate was 19.6% in the EUS-GBD group and 12.5% in the EUS-CDS group (p = 0.20), of which 10 (8.9%) and 7 (6.2%) were severe AEs respectively (p = 0.61). Bleeding occurred in seven patients (6.1%) after EUS-GBD and three patients (2.5%) after EUS-CDS, whereas five infectious events were registered after EUS-GBD (4.4%) and four cases (3.5%) after EUS-CDS (p = 0.29). No treatment-related deaths were observed. CONCLUSION: In patients with MDBO after failed ERCP, EUS-GBD or EUS-CDS were comparable with similar rates of efficacy and safety. EUS-GBD could represent an easy and safe option in MDBO patients without previous cholecystectomy and with a clear patency of the cystic duct.

Digestive EndoscopyVol. 38(4)
University of Verona (IT), Brigham and Women's Hospital (US), AOL (United States) (US), Humanitas University (IT), University of Salento (IT), Vita-Salute San Raffaele University (IT), Università Campus Bio-Medico (IT), University of Utah (US), University of Pavia (IT), Tata Memorial Hospital (IN), Haukeland University Hospital (NO), CARE Hospitals (IN), University of Utah Hospital (US), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), Hong Kong Sanatorium and Hospital (HK), Azienda Ospedaliero-Universitaria di Modena (IT), Universidad Hispanoamerica (CR), Azienda Socio Sanitaria Territoriale Lariana (IT), Policlinico Universitario di Catania (IT), Humanitas Mater Domini (IT), Nini Hospital (LB), Asian Institute of Gastroenterology (IN), Hospital General Universitario de Alicante Doctor Balmis (ES), Campus Bio Medico University Hospital (IT), Azienda di Rilievo Nazionale ed Alta Specializzazione (IT), Policlinico San Matteo Fondazione (IT), Instituto Ecuatoriano de Enfermedades Digestivas (EC), Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco" (IT), IRCCS Humanitas Research Hospital (IT), Pancreas Centre (Canada) (CA), KU Leuven (BE)
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Openalex Percentile: Top 27%
Gallbladder and Bile Duct Disorders
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