Endoscopic ultrasonography guided gallbladder drainage: "how and when".

Introduction: EUS-guided gallbladder drainage (EUS-GBD) is recognized as an effective minimally invasive alternative technique mainly in managing patients with acute cholecystitis not eligible for cholecystectomy and, more recently, for jaundice relief in inoperable patients with distant malignant biliary obstruction.

Areas covered: This review provides an extensive guide to the actual role of EUS-GBD. A comprehensive search was conducted, including articles pertinent to this review's aims. It explored technical aspects and discussed clinical scenarios most suitable for this procedure compared to other traditional drainage methods (percutaneous or endoscopic transpapillary gallbladder drainage). Moreover, the introduction of lumen-apposing metal stents (LAMS) has enhanced EUS-GBD by adding the possibility of direct gallbladder inspection and treatment of stones. The indications for performing EUS-GBD have become wider, and several robust studies described the high technical and clinical success rate with an optimal safety profile.

Expert opinion: For optimal EUS-GBD outcomes, a standardized technique and an accurate selection of patients are crucial and should benefit from a multidisciplinary team decision. Still, future efforts are required for more prospective studies to standardize clinical indications, clarify post-procedural management, and acquire new data on long-term follow-up.