Endoscopic ultrasound (EUS) effectively distinguishes between malignant and benign gallbladder wall thickening, improving surgical decision-making.

• EUS achieved a sensitivity of 79.31% and specificity of 92.86% for diagnosing gallbladder tumors.
• Key indicators of malignancy included wall thickness greater than 14 mm and disrupted wall layers; both are highly significant (p < 0.001).

Surgeons should consider EUS findings to better select patients for surgery and potentially avoid unnecessary procedures for benign conditions.