Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2023; 15(9): 574-583
Published online Sep 16, 2023. doi: 10.4253/wjge.v15.i9.574
Comparison of trans-gastric vs trans-enteric (trans-duodenal or trans-jejunal) endoscopic ultrasound guided gallbladder drainage using lumen apposing metal stents
Dheera Grover, Ifrah Fatima, Murali Dharan
Dheera Grover, Department of Internal Medicine, University of Connecticut, Farmington, CT 06030, United States
Ifrah Fatima, Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64110, United States
Murali Dharan, Department of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington, CT 06030, United States
Author contributions: Grover D and Fatima I contributed to literature search, literature inclusion for the study, and drafting of article; Dharan M contributed to conceptualization of research, literature search, critical revision of article and rewriting the discussions.
Conflict-of-interest statement: All co-authors of this manuscript confirm that there are no financial or personal relationships with any people or organizations that could inappropriately influence the actions of any author of this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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:
Corresponding author: Murali Dharan, AGAF, FASGE, MRCP, Assistant Professor, Department of Gastroenterology and Hepatology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, United States.
Received: March 20, 2023
Peer-review started: March 20, 2023
First decision: June 19, 2023
Revised: July 25, 2023
Accepted: August 23, 2023
Article in press: August 23, 2023
Published online: September 16, 2023

Endoscopic ultrasound guided gallbladder drainage (EUS-GBD) is being increasingly used in practice (either as a bridge to cholecystectomy in high-risk patients or as destination therapy in non-surgical patients). Stents are used to create a conduit between the lumen of the gallbladder (GB) and the intestinal lumen through the gastric or enteric routes. Among the various types of stents used, cautery-enhanced lumen apposing metallic stents (LAMS) may be associated with fewer adverse events (AEs).


To compare the clinical success, technical success, and rate of AEs between transgastric (TG) and trans-enteric [transduodenal (TD)/transjejunal (TJ)] approach to GB drainage. Further, we analyzed whether using cautery enhanced stents during EUS-GBD impacts the above parameters.


Study was registered in PROSPERO (CRD42022319019) and comprehensive literature review was conducted. Manuscripts were reviewed for the data collection: Rate of AEs, clinical success, and technical success. Random effects model was utilized for the analysis.


No statistically significant difference in clinical and technical success between the TD/TJ and TG approaches (P > 0.05) were noted. There was no statistically significant difference in the rate of AEs when comparing two-arm studies only. However, when all studies were included in the analysis difference was almost significant favoring the TD/TJ approach. When comparing cautery-enhanced LAMS with non-cautery enhanced LAMS, a statistically significant difference in the rate of AEs was observed when all the studies were included, with the rate being higher in non-cautery enhanced stents (14.0% vs 37.8%; P < 0.01).


As per our study results, TD/TJ approach appears to be associated with lower rate of adverse events and comparable efficacy when compared to the TG approach for the EUS-GBD. Additionally, use of cautery-enhanced LAMS for EUS-GBD is associated with a more favorable adverse event profile compared to cold LAMS. Though the approach chosen depends on several patient and physician factors, the above findings could help in deciding the ideal drainage route when both TG and TD/TJ approaches are feasible.

Keywords: Transduodenal, Transgastric, Cautery, Endoscopic ultrasound guided gallbladder drainage, AXIOS

Core Tip: Endoscopic ultrasound guided gallbladder drainage (EUS-GBD) is increasingly used in management of gallbladder disease. EUS-GBD can be achieved using trans-gastric or trans-enteric (trans-duodenal or trans-jejunal) approach There are currently no randomized controlled trials comparing these two approaches. We performed a meta-analysis of the existing literature on EUS guided gallbladder drainage. Trans-enteric approach was observed to have a more favorable safety profile compared to trans-gastric approach. Further use of cautery enhanced lumen apposing metallic stents (LAMS) to achieve EUS-guided GBD was associated with lesser adverse effects when compared to use of non-cautery enhanced (cold) LAMS.