EUS-Guided Procedures Outperform Traditional Interventions for High-Risk GI Patients

As endoscopic ultrasound (EUS)-guided procedures continue to gain traction in gastroenterology, a pair of new network meta-analyses presented at Digestive Disease Week (DDW) 2026 in Chicago, IL, offer the most comprehensive comparative data to date on their performance across key clinical outcomes.

Anjali Byale, MD, a gastroenterologist at West Virginia University, presented findings evaluating EUS-guided gallbladder drainage (EUS-GBD) for high-risk acute cholecystitis and direct EUS-guided gastroenterostomy (EUS-GE) for malignant gastric outlet obstruction (GOO), 2 conditions that have historically required surgical management.

"In the last 10 to 12 years, the trend has been more toward EUS-guided procedures," Byale told HCPLive. "These are procedures we can do on an outpatient basis — patients come in the morning and, if everything goes well, go home the same day."

EUS-GBD for High-Risk Acute Cholecystitis

The first study pooled data from 14 comparative studies published between 2012 and 2021, encompassing 1410 patients with a weighted mean age of 67.8 years. EUS-GBD was compared against laparoscopic cholecystectomy (LC), percutaneous gallbladder drainage (PC-GBD), endoscopic transpapillary gallbladder stenting (ETGS), and endoscopic naso-gallbladder drainage (EN-GBD).

Results showed EUS-GBD demonstrated superior clinical success compared with ETGS and was non-inferior to LC and PC-GBD. Technical success and adverse event rates were comparable across modalities. The most striking finding, however, was in reintervention: patients who underwent PC-GBD were nearly 9 times more likely to require reintervention than those who received EUS-GBD (odds ratio [OR], 8.76; 95% CI, 4.38-174.39).

"For someone who is a poor surgical candidate, we don't want to put them through anesthesia multiple times," Byale said. "Reintervention rates really matter, and EUS-GBD has a clear advantage there."

Direct EUS-GE for Malignant Gastric Outlet Obstruction

The second meta-analysis drew from 23 retrospective studies published between 2017 and 2025, totaling 2604 patients, comparing direct EUS-GE against enteral stenting (ES) and surgical gastrojejunostomy (SGJ) for malignant GOO.

Clinical success was comparable across all three modalities. However, SGJ carried significantly higher adverse event rates than EUS-GE (OR, 6.55; 95% CI, 3.38–12.69), and ES was associated with substantially higher reintervention rates (OR, 4.18; 95% CI, 1.60–10.90), largely driven by stent migration. While ES demonstrated the highest technical success, Byale cautioned against prioritizing that metric at the expense of durability and safety.

"We cannot compromise clinical success, that is the most important thing," she said. "But once procedures are comparable on that front, adverse events and reintervention become critical factors, especially for patients who are expected to live longer."

Institutional Capabilities and Patient Selection

Byale noted that EUS-guided procedures require advanced endoscopy expertise not available at all centers, and that LC, PC-GBD, and ES remain viable options where EUS capability is limited. The overarching message, she emphasized, is that clinical decision-making must weigh institutional resources, patient prognosis, and the full constellation of outcomes, not technical success alone.

Editors’ note: Byale reports no relevant disclosures.

References

1. Byale A, Adoor DM, Moond V, et al. EUS-GBD STRIKES THE OPTIMAL BALANCE OF SUCCESS, SAFETY, AND REINTERVENTION IN HIGH-RISK ACUTE CHOLECYSTITIS: A NETWORK META-ANALYSIS. Presented at Digestive Disease Week (DDW) 2026 in Chicago, IL, May 2-5, 2026.

2. Byale A, Adoor DM, Moond V, et al. DIRECT EUS-GE OUTPERFORMS ES AND SGJ IN SAFETY AND REINTERVENTION WHILE MATCHING CLINICAL SUCCESS: A 23-STUDY NETWORK META-ANALYSIS. Presented at Digestive Disease Week (DDW) 2026 in Chicago, IL, May 2-5, 2026.