Endoscopic ultrasound-guided gallbladder drainage with or without prior percutaneous transhepatic gallbladder drainage: a multicenter retrospective cohort study

Abstract Percutaneous transhepatic gallbladder drainage (PTGBD) is performed for acute cholecystitis in surgically unfit patients; however, there is a risk of recurrence after tube removal. We aimed to evaluate clinical outcomes of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) across two distinct pathways – primary EUS-GBD (pEUS-GBD) and conversion from PTGBD as an internalization strategy (cEUS-GBD). This multicenter retrospective study included 239 surgically unfit patients with acute cholecystitis who underwent pEUS-GBD (n = 180) or cEUS-GBD (n = 59). The primary outcome was pathway-defined procedural success: initial drainage success for pEUS-GBD and internalization success for cEUS-GBD. Propensity-score overlap weighting was applied. Procedural success was high in both groups (95.6% vs. 93.2%; P = 0.50). Mean (SD) procedure time was significantly shorter for pEUS-GBD (8.4 [6.6] vs. 12.9 [7.1] minutes; P < 0.001). Early adverse events did not differ significantly between the groups (10.6% vs. 11.9%; P = 0.78). Among successful cases, late adverse events (4.1% vs. 7.3%; P = 0.47) and recurrence (5 cases [2.9%] vs. 0 cases [0%]) did not differ significantly. Findings were generally consistent after overlap weighting, and mean procedure time remained shorter with pEUS-GBD (7.4 [2.8] vs. 12.0 [5.1] minutes; P < 0.001). Both approaches achieved high procedural success within their respective distinct pathways. Prior PTGBD did not appear to compromise subsequent EUS-GBD, suggesting that cEUS-GBD may serve as a valid internalization option in selected patients after initial PTGBD. The shorter procedure time with pEUS-GBD should be interpreted as a workflow-related finding, and the index gallbladder drainage modality should be individualized according to clinical stability, anatomic feasibility, and available endoscopic resources.