Endoscopic ultrasound-guided gallbladder drainage for bilirubin normalization in distal malignant biliary obstruction: A focused review

Endoscopic transpapillary biliary drainage is currently recommended as the gold standard treatment modality for distal malignant biliary obstruction (DMBO) with endoscopic ultrasound (EUS)-guided biliary drainage being advocated in cases of endoscopic retrograde cholangiopancreatography failure. EUS-guided gallbladder drainage (GBD) has recently been proposed as a promising "rescue" and first-line alternative tool for managing DMBO. Indeed, high rates of both technical and clinical success along with a favorable safety profile have been reported. However, evidence regarding the capability of EUS-GBD to normalize total bilirubin in patients with DMBO is still lacking. Notably, bilirubin normalization is regarded as mandatory before starting chemotherapy, thus representing a crucial outcome of any biliary drainage method for DMBO. Our study aimed to summarize and discuss the current evidence concerning the effectiveness of EUS-GBD for bilirubin normalization in DMBO.