EUS-guided gallbladder drainage for rescue treatment of malignant distal biliary obstruction after unsuccessful ERCP

Gastrointest Endosc. 2016 Jul;84(1):147-51. doi: 10.1016/j.gie.2015.12.024. Epub 2016 Jan 5.


Background and aims: EUS-guided bile duct drainage (EUS-BD) is a well-recognized rescue biliary drainage method after unsuccessful ERCP. EUS-guided gallbladder drainage (EUS-GBD) was recently used to treat acute cholecystitis. The aim of this study was to assess the efficacy and safety of EUS-GBD for malignant biliary stricture-induced obstructive jaundice after unsuccessful ERCP as well as unsuccessful or impractical EUS-BD.

Methods: Between January 2006 and October 2014, 12 patients with obstructive jaundice due to unresectable malignant distal biliary stricture underwent EUS-GBD after ERCP failed. EUS-GBD was performed under the guidance of EUS and fluoroscopy by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a stent. The technical and functional success rates, adverse events rate, overall patient survival time, and stent dysfunction rate during patient survival were measured.

Results: The rates of technical success, functional success, adverse events, and stent dysfunction were 100%, 91.7%, 16.7%, and 8.3%, respectively. The median survival time after EUS-GBD was 105 days (range 15 - 236 days).

Conclusions: EUS-GBD is a possible alternative route for decompression of the biliary system when ERCP is unsuccessful.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bile Duct Neoplasms / complications
  • Cholangiopancreatography, Endoscopic Retrograde
  • Cholecystostomy / methods*
  • Cholestasis / etiology
  • Cholestasis / surgery*
  • Drainage / methods
  • Endosonography / methods
  • Female
  • Gallbladder / surgery*
  • Humans
  • Jaundice, Obstructive / etiology
  • Jaundice, Obstructive / surgery*
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Pancreatic Neoplasms / complications
  • Retrospective Studies
  • Surgery, Computer-Assisted
  • Treatment Failure