This study aims to assess and compare the outcomes of EUS-GBD in patients presenting with acute cholecystitis (AC) versus those treated for non-cholecystitis indications (NC).

We conducted a retrospective single-center study including all consecutive patients who underwent EUS-GBD for any indication (AC or NC) between May 2020 and October 2025. We compared technical success—defined as appropriate LAMS placement within the gallbladder confirmed by EUS—clinical success (based on clinical and laboratory improvement), adverse event (AE) rates, and mortality between the AC and NC groups. All procedures were performed by an endoscopist (S.M) with advanced training in interventional EUS. Statistical analyses were performed using Jamovi software version 2.3.

A total of 38 patients underwent EUS-GBD; 65.8% were male, with a mean age of 67.2 ± 15.3 years. Overall, 65.8% were treated for AC. NC indications included symptomatic gallstones (15.8%), malignant biliary obstruction (5.3%), symptomatic common bile duct stones (2.6%), and gallstone pancreatitis (2.6%). Most stents were deployed via a transgastric approach (88.8%), with the remainder placed transduodenally (11.2%). Technical success was 100% in both groups. AEs occurred in 18.4% of cases: 13.2% in the AC group and 5.3% in the NC group (p = 0.728). Clinical success was achieved in 84.2% of the cohort (Table.1). One patient died within one month of follow-up; both belonged to the NC group and had malignant biliary obstruction. Another patient, from the AC group, died within one month of follow-up.

Table.1 Baseline Characteristics and procedural results of patients who underwent EUS-GB procedures

EUS-GBD demonstrated excellent technical success and favorable clinical outcomes across both acute cholecystitis and non-cholecystitis indications. AE rates were low and comparable between groups. Overall, EUS-GBD appears to be a safe, effective, and versatile drainage strategy not only for acute cholecystitis but also for selected non-cholecystitis conditions.