CHOLEBLADEUS: long-term results of endoscopic ultrasound-guided gallbladder versus bile duct drainage of malignant biliary obstruction after failed ERCP: a propensity-matched study.

Before matching, 294 patients were included (142 EUS-GBD; 152 EUS-CDS). After matching, 200 patients were analyzed (100 per group). Technical success was 100% for EUS-GBD and 97% for EUS-CDS (P = 0.25). Clinical success was 80.5% for EUS-GBD and 90.6% for EUS-CDS (P = 0.08). At 12 months, the probability of biliary patency was significantly higher with EUS-GBD than EUS-CDS (86.2% [95%CI 74.2%-92.9%] vs. 63.8% [95%CI 49.5-75.0]; P = 0.01). Biliary reintervention-free survival was significantly longer with EUS-GBD (log-rank, P < 0.001). Periprocedural AEs occurred in 7.0% vs. 10.0% (P = 0.61), delayed AEs in 27.0% vs. 30.0% (P = 0.75), and reintervention rates were comparable (23.0% vs. 26.0%; P = 0.74). Overall survival did not differ significantly (log-rank, P = 0.59). Conclusion In patients with MDBO after failed ERCP, EUS-GBD achieved higher 12-month biliary patency than EUS-CDS, with comparable rates of technical and clinical success, morbidity, reintervention, and overall survival.