Effectiveness of endoscopic ultrasound (EUS)‐guided choledochoduodenostomy vs. EUS‐guided gallbladder drainage for jaundice in patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography: Retrospective, multicenter study (GALLBLADEUS Study)

Objectives The aim of this study was to compare endoscopic ultrasound‐guided choledochoduodenostomy (EUS‐CDS) vs. EUS‐gallbladder drainage (EUS‐GBD) in cases of failed endoscopic retrograde cholangiopancreatography (ERCP) for jaundice resulting from malignant distal biliary obstruction (MDBO). Methods This multicenter retrospective study included patients with obstructive jaundice secondary to MDBO who underwent EUS‐GBD or EUS‐CDS with lumen‐apposing metal stents after failed ERCP. The primary end‐point was clinical success rate. Secondary end‐points were technical success, periprocedural adverse events rate (24 h), overall survival, and time to recurrent biliary obstruction. Results A total of 78 patients were included: 41 underwent EUS‐GBD and 37 underwent EUS‐CDS. MDBO was mainly the result of pancreatic cancer ( n = 63/78, 80.7%). Clinical success rate was similar for both procedures: 87.8% for EUS‐GBD and 89.2% for EUS‐CDS ( P = 0.8). Technical success rate was 100% for EUS‐GBD and 94.6% for EUS‐CDS ( P = 0.132). Periprocedural morbidity (24 h) among patients in the EUS‐CDS group (8/37 21.6%) than in the EUS‐GBD group (3/41 7.3%) ( P = 0.042). The median follow‐up duration was 4.7 months. Overall survival and time to recurrent biliary obstruction did not significantly differ between the groups. Discussion After failed ERCP for MDBO, EUS‐GBD and EUS‐CDS show comparable clinical success rates and technical success. EUS‐GBD appears to be a promising alternative for MDBO, even as a second‐line treatment after failed ERCP. Further studies are needed to validate these findings and compare the long‐term outcomes of EUS‐GBD and EUS‐CDS.