Endoscopic ultrasound guided gallbladder drainage (EUS-GBD) with lumen apposing metal stent (LAMS) has become a favourite drainage option for high surgical-risk patients with acute cholecystitis and as rescue treatment for the relief of jaundice in patients with distal malignant biliary obstruction (DMBO) with high technical and clinical success.

The placement of naso-cystic drainage (NCD) to favour drainage and for lavage is not routinary recommended and there are no data on its use.

We aim to assess the role of NC tube in term of rate of length of hospitalization, rate of obstruction and unplanned readmissions and re-interventions.

Single center retrospective analysis of all consecutive cases of EUS-GBD with LAMS acceding to the Therapeutic Endoscopy Unit of Fondazione Policlinico Universitario Campus Bio-Medico of Rome. Data about LAMS features and procedure were collected.

From January 2019 to October 2025 sixty-seven patients were enrolled (50.7% male; 77±12 years old). The 65.6% of them underwent EUS-GBD for acute cholecystitis. In 51% patients the trans-gastric access was performed. In 71.7% patients a Hot-Axios LAMS was used and in the majority of procedure (79.1%) a calibre bigger than 10 mm was used. Overall technical success was obtained in 98.5% of procedures.

A naso-cystic tube was placed inside the LAMS in 33/67 (49.3%) patients. Regarding the adverse events rate, in one patient distal flange misdeployment occurred. LAMS obstruction occurred in 7/67 patients (10.4%) and need of reintervention in 11/67 (16.4%). 

There was no difference in term of drainage indication (61.7% vs 69.6% p 0.6), LAMS size (70.5% vs 87.8% p 0.13) and the placement of NCD. The rate of LAMS obstruction (6.7% vs 15.2% p 0.45) and reintervention (20.8% vs 25% p 1) was similar between th group of patients with NCD and without. The mean time of hospitalization after gallbladder drainage was not different between the two groups (11±9 vs 8±6 p 0.09). 

EUS-GBD is a safe technique with high technical success rate. The placement of naso-cystic drainage doesn’t affect the post procedure outcome and doesn’t reduce the length of hospital stay.