Endoscopic ultrasound–guided gallbladder drainage (EUS-GBD) has emerged as an important alternative for high-risk surgical candidates with acute cholecystitis. While lumen-apposing metal stents (LAMS) are widely reported, their impact on subsequent cholecystectomy remains a concern. We have adopted a gallbladder flushing technique using a plastic stent during EUS-GBD. This study aimed to evaluate the technical and clinical outcomes of this approach and compare them with the transpapillary technique.

We retrospectively reviewed 63 patients who underwent endoscopic treatment for acute cholecystitis at Showa Medical University Koto Toyosu Hospital between April 2023 and October 2025. Outcomes assessed included technical and clinical success, adverse events, procedure time, and postoperative surgical course.

A total of 63 patients were included, with a median age of 81 years (range 28–98). The transpapillary approach was performed in 43 patients, whereas 20 underwent EUS-GBD. Among the EUS-GBD procedures, technical success was achieved in 95% (19/20), with one case requiring conversion to LAMS placement. Clinical success was obtained in all patients who underwent EUS-GBD. The median procedure time was 30 minutes (range 17–44). Two patients (10%) developed peritonitis after the procedure, and both recovered with conservative management. In the transpapillary group, the cystic duct was successfully selected and the guidewire advanced into the gallbladder in 37 of 43 patients (93.3%). Whenever guidewire placement was successful, endoscopic gallbladder stenting was completed without failure. No adverse events occurred in this group. The median procedure time was 38 minutes (range 18–118), which was significantly longer than that of EUS-GBD (p = 0.004). Importantly, seven patients from the EUS-GBD group subsequently underwent cholecystectomy, and none experienced complications attributable to the prior procedure. No difficulties related to the plastic stent or the flushing method were encountered during laparoscopic dissection, suggesting that the procedure is unlikely to interfere with subsequent surgery.

A plastic stent–based gallbladder flushing method in EUS-GBD demonstrated excellent technical and clinical success. Although minor adverse events were observed, overall procedure time was significantly shorter than the transpapillary approach. Importantly, no difficulties were encountered during subsequent cholecystectomy. In addition, plastic stents may offer advantages in terms of medical cost compared with metallic stents. These findings suggest that this technique is a useful and feasible therapeutic option for acute cholecystitis, particularly in patients unsuitable for immediate surgery.