Use of endoscopic ultrasound-guided gallbladder drainage as a rescue approach in cases of unsuccessful biliary drainage

Table 1 Types of currently available lumen-apposing metal stents

Stent	Flare diameter (mm)	Lumen diameter (mm)	Length (mm)	Electrocautery enhanced tip
AXIOS stent (Boston Scientific Co., Marlborough, MA, United States)	21, 24, 29	6, 8, 10, 15, 20	10, 15	Yes
SPAXUS stent (Taewoong Medical Co., Gimpo, Korea)	23, 25, 31	8, 10, 16	20	Yes
NAGI stent (Taewoong Medical Co., Gimpo, Korea)	20	10, 12, 14, 16	10, 20, 30	No

Table 2 Studies comparing endoscopic ultrasound-guided gallbladder drainage vs percutaneous transhepatic gallbladder drainage outcomes for acute cholecystitis

Ref.	Number of patients	Procedure	Technical success (%)	Clinical success (%)	Adverse events (%)
Jang et al[28]	59	EUS-GBD	97	100	7
		PTGBD	97	96	3
Kedia et al[29]	73	EUS-GBD	97.6	97.6	13.3
		PTGBD	100	86.7	39.5
Teoh et al[30]	118	EUS-GBD	96.6	89.8	32.2
		PTGBD	100	94.9	74.6
Irani et al[31]	90	EUS-GBD	98	96	11
		PTGBD	100	91	32
Tyberg et al[32]	155	EUS-GBD	95	95	21.4
		PTGBD	99	86	21.2

EUS-GBD: Endoscopic ultrasound-guided gallbladder drainage; PTGBD: Percutaneous transhepatic gallbladder drainage.

Table 3 Studies presenting procedural outcomes of endoscopic ultrasound-guided gallbladder drainage as a rescue approach

Ref.	Number of patients	Procedure	Technical success rate (%)	Clinical success rate (%)	Adverse events rate (%)
Imai et al[5], 2016	12	EUS-GBD with SEMS	100	91.7	16.7
Issa et al[4], 2021	28	EUS-GBD with LAMS	100	92.6	16.7
Binda et al[25], 2023	48	EUS-GBD with LAMS	100	81.3	10.4
Chang et al[33], 2019	9	EUS-GBD with LAMS	100	77.78	11.1

EUS-GBD: Endoscopic ultrasound-guided gallbladder drainage; LAMS: Lumen-apposing metal stents; SEMS: Self-expandable metal stents.

Table 4 A table comparing the advantages and limitations of endoscopic ultrasound-guided gallbladder drainage with other drainage options in case of distal malignant biliary obstruction

Drainage option	Advantages	Limitations
ERCP	Established technique, high success rates, can manage multiple strictures	Limited by anatomy, requires skilled operators, can cause pancreatitis
PTBD	High technical success rate, effective in cases of ERCP failure and altered anatomy	Associated with higher complication rates, requires external drainage, decreased quality of life, risk of multiple reintervention
EUS-BD	Access intrahepatic or extrahepatic duct, no risk of pancreatitis, can manage failed ERCP cases	Limited availability, requires skilled operators, higher cost
EUS-GBD	Can avoid transpapillary access, can manage acute cholecystitis, can manage failed ERCP and EUS-BD cases	Limited data on long-term outcomes, risk of gallbladder perforation or bleeding, limited applicability in cases of obstructed cystic duct

EUS-GBD: Endoscopic ultrasound-guided gallbladder drainage; PTBD: Percutaneous transhepatic biliary drainage; EUS-BD: Endoscopic ultrasound biliary drainage; ERCP: Endoscopic retrograde cholangiopancreatography.