Endoscopic ultrasound-guided gallbladder drainage for jaundice: Response to Vanella et al.

Abstract

We appreciate Vanella et al.'s insightful letter regarding our GALLBLADEUS study.¹ They correctly noted that endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) may have appeared as a third-line option. Due to our retrospective data, we lack specific details, but in our center, EUS-GBD is often preferred over endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) after failed endoscopic retrograde cholangiopancreatography, with many patients receiving EUS-GBD as a second-line treatment.

We fully agree with Vanella's remark that the presence of duodenal stenosis makes the use of EUS-CDS inappropriate. However, the patients included in this study were treated at a time when this information had not yet been published, particularly by the CABRIOLET trial² conducted by our correspondents. The proportion of patients with duodenal stenosis was significant but comparable in both groups (48.7% EUS-CDS vs. 41.5% EUS-GBD). However, despite this, our study still showed that dysfunctions seemed less frequent in the EUS-GBD group.

Emerging evidence suggests hepaticogastrostomy as a better route for duodenal stenosis,^{2, 3} although it has a longer learning curve compared to EUS-GBD, which is simpler for less-experienced centers. Our study suggests fewer dysfunctions with EUS-GBD vs. EUS-CDS in this context, a finding that needs confirmation from future prospective, comparative studies as suggested by Vanella et al. We agree that biliary drainage far from the tumor warrants comparing EUS-GBD to hepaticogastrostomy. The significant proportion of duodenal stenosis in our study favors EUS-GBD, suggesting fewer dysfunctions, although this needs confirmation by future studies. This question is of interest because EUS-GBD is simpler for less-experienced centers and could be more widely adopted than hepaticogastrostomy. Future prospective studies comparing EUS-CDS, EUS-GBD, and hepaticogastrostomy across various clinical scenarios are essential. We thank Vanella et al. for their valuable input and look forward to further dialogue and research in this evolving field.

Authors declare no conflict of interest for this article.