Endoscopic Ultrasound-Guided Gallbladder Drainage Using Double-Pigtail Plastic Stents for Acute Cholecystitis in Patients with Malignant Biliary Obstruction

Background/Objectives: Acute cholecystitis in patients with malignant biliary obstruction (MBO) is challenging to manage. Evidence for endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using double-pigtail plastic stents (DPPS) in this setting remains limited. We evaluated the efficacy and safety of EUS-GBD using DPPS for acute cholecystitis in patients with MBO. Methods: We retrospectively reviewed 41 consecutive patients who underwent EUS-GBD using DPPS at two centers. The primary endpoint was technical success; secondary endpoints included clinical success, adverse events, recurrence, and subsequent oncologic treatment. Results: Technical success was achieved in 95.1% (39/41), with clinical success in all technically successful cases. Adverse events included biliary peritonitis (14.6%) and procedure-related DPPS migration (2.4%). Recurrence occurred in 2.6% of patients. Systemic therapy was resumed in 10 of 18 patients (55.6%) at a median of 15 days after EUS-GBD. Conclusions: EUS-GBD using DPPS achieved high technical and clinical success rates with a low recurrence rate in selected patients with acute cholecystitis and MBO. Systemic therapy could be resumed in a subset of patients following successful drainage. These findings suggest that DPPS-based EUS-GBD may be a feasible internal drainage option in this setting, although prospective comparative studies are needed to further establish its safety and effectiveness.