Technical Evolution, Clinical Application, and Outcomes of Endoscopic Transpapillary Gallbladder Drainage in Acute Cholecystitis: A Review

Background: Acute cholecystitis (AC) is a common inflammatory disease of the gallbladder. Although laparoscopic cholecystectomy remains the standard treatment, gallbladder drainage may be required in patients who are unsuitable for early surgery. Endoscopic transpapillary gallbladder drainage (ETGBD), including endoscopic nasogallbladder drainage (ENGBD) and endoscopic gallbladder stenting (EGBS), has increasingly been used as a minimally invasive internal drainage approach. Aims: This review aims to clarify the role of ETGBD in AC by integrating stepwise technical failure analysis with a practical selection framework among other drainage techniques. Methods: This narrative review was conducted through a structured literature search of PubMed, Embase, Web of Science, and the Cochrane Library up to 30 April 2026. Results: ETGBD preserves native gallbladder anatomy and may have specific value in selected patients, particularly when gallbladder preservation is desirable or concomitant endoscopic retrograde cholangiopancreatography (ERCP) is indicated. Recent technical developments, including cholangioscopy and advanced drainage devices, may support procedural planning and clinical management in selected difficult cases. Compared with percutaneous transhepatic gallbladder drainage (PTGBD) or endoscopic ultrasound-guided gallbladder drainage (EUS-GBD), ETGBD should be regarded as a complementary option rather than a universal substitute, and its application remains limited by variable technical success, cystic duct anatomy, operator expertise, and center experience. However, ETGBD may also be combined with other techniques, providing additional options in selected complex clinical scenarios. Conclusions: Adequately powered multicenter comparative studies with standardized outcome definitions are needed to clarify the optimal role, safety, recurrence risk, and long-term stent management of ETGBD.