Internal Gallbladder Drainage in Non-Operative Patients: Outcomes and SIR-Graded Adverse Events

Purpose: To synthesize outcomes of internal gallbladder drainage in non-operative patients across transpapillary endoscopic stenting (ETGS/EGBS), endoscopic ultrasound-guided gallbladder drainage (EUS-GBD), and percutaneous tract-matured internalization, with adverse events (AEs) regraded using numerical Society of Interventional Radiology (SIR) criteria.

Materials and Methods: A structured scoping review (PRISMA-ScR) identified 523 studies across 6 databases. Nine studies meeting the inclusion criteria underwent full-text review, encompassing 435 patients across internal drainage strategies. Two reviewers independently extracted patient selection, access route, device specifications, clinical intent, technical/clinical success, patency metrics, and complications. All reported AEs were systematically mapped to numerical SIR grades (1–6) based on management requirements and clinical severity indicators. Given heterogeneity and small sample sizes, the data synthesis was descriptive.

Results: Technical success was high across modalities (ETGS/EGBS 79-98%; percutaneous 91%). AE profiles differed mechanistically: transpapillary approaches showed durable patency (median 760 days) with papillary-related AEs (pancreatitis/cholestasis 8.7% each, SIR-3). EUS-GBD achieved immediate internalization but generated tract-specific complications, including pneumoperitoneum (3.2%), perforation (1.6%), and bile leak (16.7%) in conversions. Percutaneous internalization yielded the lowest major AE rates (SIR-3/4: 10%, 30-day mortality 3.0%). Multicenter data favoured permanent EGBS over drain removal (n=180; late AEs 5.0% vs 22.1%, p=0.002).

Conclusion: Internal drainage demonstrates consistent feasibility with route-specific risk profiles, enabling evidence-based selection. Transpapillary EGBS provides superior durability with manageable pancreaticobiliary risks. EUS-GBD offers immediate internalization at the cost of transmural complications. Percutaneous internalization may be optimal for frail patients when cystic-duct access is feasible.

AI disclosure: During the preparation of this work, the author used Claude Sonnet 4 in order to improve grammar, spelling, and readability of the submission.