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Review
. 2025 Jun 13;17(12):1983.
doi: 10.3390/cancers17121983.

EUS-Guided Gallbladder Drainage of Inoperable Malignant Distal Biliary Obstruction by Lumen-Apposing Metal Stent: Systematic Review and Meta-Analysis

Tawfik Khoury  1   2   3 , Moaad Farraj  4 , Wisam Sbeit  1   2 , Pietro Fusaroli  5 , Giovanni Barbara  6   7 , Cecilia Binda  8 , Carlo Fabbri  8 , Maamoun Basheer  1   2 , Sarah Leblanc  3 , Fabien Fumex  3 , Rodica Gincul  3 , Anthony Yuen Bun Teoh  9 , Jérémie Jacques  10 , Bertrand Napoléon  3 , Andrea Lisotti  3   5
Affiliations
Review

EUS-Guided Gallbladder Drainage of Inoperable Malignant Distal Biliary Obstruction by Lumen-Apposing Metal Stent: Systematic Review and Meta-Analysis

Tawfik Khoury et al. Cancers (Basel). .

Abstract

Objective: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged as a promising alternative for biliary decompression in patients with malignant distal biliary obstruction (MDBO), used either as a first-line approach or after other interventions have failed. This study aimed to evaluate the aggregated efficacy and safety of EUS-GBD in this patient population. Methods: A comprehensive literature search was carried out across PubMed/Medline, Embase, and Cochrane databases up to 9 January 2024, to identify studies reporting outcomes of EUS-GBD in MDBO cases. The primary endpoint assessed was clinical success, while secondary endpoints included technical success and the incidence of adverse events (AEs). Pooled outcomes were calculated using a random-effects model and presented with 95% confidence intervals (CIs). Results: Seven studies encompassing a total of 193 patients were included in the analysis. The combined clinical success rate for EUS-GBD was 88.1% [95% CI: 78.9-94.9%], while the technical success rate was 99.2% [95% CI: 97.5-100%]. The overall AE rate was 13.7% [95% CI: 9.3-18.8%], with the majority being mild to moderate in severity; no fatal complications were reported. Subgroup analyses indicated that use of smaller lumen-apposing metal stents (LAMS) (<15 mm) was associated with slightly higher clinical success (93.3% [95% CI: 72.4-99.9%]) compared to larger stents (≥15 mm) (87.1% [95% CI: 78.8-93.5%]), and a marginally lower rate of AEs (12.3% [95% CI: 6.4-19.7%] vs. 15.2% [95% CI: 6.5-26.6%]). Conclusions: EUS-GBD demonstrates excellent technical performance, high clinical efficacy, and a manageable safety profile in patients with MDBO and a patent cystic duct.

Keywords: biliary obstruction; drainage; efficacy; gallbladder drainage; safety.

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Conflict of interest statement

B. Napoléon has delivered a teaching session for Taewoong and is a consultant for Boston Scientific. A. Lisotti, P. Fusaroli, C. Fabbri, C. Binda, and F. Fumex are consultants for Boston Scientific. A.Y.B. Teoh is a consultant for Boston Scientific, Cook, Taewoong, Microtech, and MI Tech Medical. T. Khoury, M. Farraj, W. Sbeit, M. Basheer, R. Gincul, S. Leblanc, and J. Jacques declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of the study. * Records identified through primary electronically search ** Studies excluded, as they were obviously irrelevant studies (n = 237), and abstract without full-text manuscript that was published within 3 years (n = 1).
Figure 2
Figure 2
Forrest plot reporting pooled estimates for clinical success rate [9,10,11,12,13,14,15].
Figure 3
Figure 3
Forrest plot reporting pooled estimates for technical success rate [9,10,11,12,13,14,15].
Figure 4
Figure 4
Forrest plot reporting pooled incidence of adverse events rate [9,10,11,12,13,14,15].
See this image and copyright information in PMC

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