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

doi:10.4253/wjge.v18.i2.114771

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World Journal of Gastrointestinal Endoscopy

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World J Gastrointest Endosc. Feb 16, 2026; 18(2): 114771
Published online Feb 16, 2026. doi: 10.4253/wjge.v18.i2.114771

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

Alberto Martino, Antonino Granata, Francesco Paolo Zito, Roberto Fiorentino, Raffaele Bennato, Savio Saviano, Annalisa de Leone, Pietro Graceffa, Mario Ricchiuti, Luigi Orsini, Enrico Crolla, Giovanni Sarnelli, Fabio Cartabellotta, Giovanni Lombardi

Alberto Martino, Francesco Paolo Zito, Raffaele Bennato, Savio Saviano, Annalisa de Leone, Mario Ricchiuti, Luigi Orsini, Giovanni Lombardi, Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy

Antonino Granata, Pietro Graceffa, Interventional Endoscopic Unit, Buccheri La Ferla Hospital, Palermo 90123, Italy

Roberto Fiorentino, Department of Oncology, AORN “Antonio Cardarelli”, Napoli 80131, Italy

Mario Ricchiuti, Giovanni Sarnelli, Department of Clinical Medicine and Surgery, Federico II University of Naples, Napoli 80131, Italy

Enrico Crolla, Department of Oncological Surgery, AORN “Antonio Cardarelli”, Napoli 80131, Italy

Fabio Cartabellotta, Department of Internal Medicine, Buccheri La Ferla Hospital, Palermo 90123, Italy

Co-first authors: Alberto Martino and Antonino Granata.

Author contributions: Martino A, Granata A, and Zito FP designed the research and wrote, edited, and finalized the text; Martino A, Granata A, Zito FP, Fiorentino R, Bennato R, Saviano S, de Leone A, Graceffa P, Ricchiuti M, Orsini L, and Crolla E performed the literature search and analyzed the data; Sarnelli G, Cartabellotta F, and Lombardi G reviewed the paper for important intellectual content; Martino A and Granata A have contributed equally to this work and are co-first authors; All authors read and approved the final manuscript.

Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Alberto Martino, MD, Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Via Antonio Cardarelli 9, Napoli 80131, Italy. alberto.martino@aocardarelli.it

Received: September 28, 2025
Revised: October 30, 2025
Accepted: December 1, 2025
Published online: February 16, 2026
Processing time: 129 Days and 14.4 Hours

Abstract

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.

Keywords: Endoscopic ultrasound-guided gallbladder drainage; Distal malignant biliary obstruction; Biliary drainage; Endoscopic ultrasound-guided biliary drainage; Endoscopic retrograde cholangiopancreatography

Core Tip: Endoscopic ultrasound (EUS)-guided gallbladder drainage (GBD) has recently been proposed as a promising “rescue” and first-line option for managing distal malignant biliary obstruction (DMBO). Indeed, high rates of both technical and clinical success along with low adverse events rates have been reported. However, evidence concerning the effectiveness of EUS-GBD for bilirubin normalization in DMBO is currently still lacking. Our study aimed to review the current evidence about the efficacy of EUS-GBD for bilirubin normalization in patients with DMBO.