Simple SummaryEndoscopic ultrasound-guided gallbladder drainage is emerging as an important technique for patients with malignant biliary obstruction where ERCP has failed. This meta-analysis is conducted to evaluate the efficacy and safety of this procedure. A comprehensive search of key databases was conducted, and all relevant studies were interrogated. A total of 7 studies were included in the final analysis with a total of 136 patients. The pooled clinical success rate of the procedure was 85%. Adverse events occurred in 13% of cases. No severe adverse events were reported. This meta-analysis supports the use of endoscopic ultrasound-guided drainage in malignant biliary obstruction when standard treatment has failed.AbstractBackground: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is a rescue technique for patients with malignant biliary obstruction who fail conventional treatment with ERCP or EUS-guided biliary drainage. The technique has been successfully employed in the management of acute cholecystitis in patients not fit for surgery. However, the evidence for its use in malignant obstruction is less robust. This review article aims to evaluate the data available at present to better understand the safety and efficacy of EUS-guided gallbladder drainage. Methods: A detailed literature review was conducted and several databases were searched for any studies relating to EUS-GBD in malignant biliary obstruction. Pooled rates with 95% confidence intervals were calculated for clinical success and adverse events. Results: Our search identified 298 studies related to EUS-GBD. The final analysis included 7 studies with 136 patients. The pooled rate of clinical success (95% CI) was 85% (78–90%, I2: 0%). The pooled rate of adverse events (95% CI) was 13% (7–19%, I2: 0%). Adverse events included: peritonitis, bleeding, bile leakage, stent migration, and stent occlusion. No deaths directly related to the procedure were reported; however, in some of the studies, deaths occurred due to disease progression. Conclusion: This review supports the use of EUS-guided gallbladder drainage as a rescue option for patients who have failed conventional measures.