We thank the authors for their interest in our report on endoscopic ultrasound-guided gallbladder drainage (EUS-GBD).1 Management of gallbladder disease is not within the sole domain of gastroenterologists. It includes surgeons and interventional radiologists. When guidelines are developed without multidisciplinary consensus, problems can occur as reported in our series.2 The distinction between never-surgery and high-risk surgical patients is more than semantics. The former includes patients with end-stage lung disease such as pulmonary hypertension, irreversible severe vascular disease, end-stage cardiac disease in non-transplant patients, active inoperable malignancy and liver cirrhosis with portal hypertension. Performing EUS-GBD in this patient cohort is a no-brainer. In others, multidisciplinary consensus is critical.3

The multicentre case-control (1:2 match between EUS and percutaneous cohorts) study cited by authors in defence of EUS is retrospective, underpowered and does not stratify for disease severity.4 In …