Transgastric endoscopic ultrasound (EUS)-guided gallbladder drainage for acute cholecystitis.

patients with a covered metallic stent (CMS) placed in the bile duct [1,2]. Percutaneous transhepatic gallbladder drainage, which involves an external drainage tube, decreases the ability of the patient to carry out their normal daily activities. Recently, endoscopic ultrasound (EUS)guided drainage has been employed successfully for hepatogastrostomy, bilioduodenostomy, and pancreatogastrostomy [3–5]. We report here a patient who underwent EUS-guided gallbladder drainage for acute cholecystitis caused by CMS placement. A 71-year-oldmanwith unresectable pancreatic cancer underwent deployment of a CMS for obstructive jaundice. On the eighth post-procedure day, he complained of abdominal pain and developed fever, associatedwith an increase inwhite blood cell counts and raised serum level of C-reactive protein. Computed tomography revealed an enlargedgallbladder, suggesting acute cholecystitis and requiring continuous drainage of the gallbladder. Therefore, after obtaining informed consent, we carried out EUS-guided gallbladder drainage. An echoendoscope (GF-UCT240-AL5; Olympus, Tokyo, Japan) was introduced into the stomach, and a 19-gauge needle (Echo-Tip; Wilson-Cook, Winston-Salem, North Carolina, USA)was used to puncture the gallbladder (●" Fig. 1) and create a gastro-gallbladder fistula. The infected bile was immediately aspirated via the needle and the gallbladder was irrigated with a contrast medium containing an antibiotic. A 0.035-inch guide wire (Revowave, Olympus, Tokyo, Japan) was passed through the needle under fluoroscopic guidance until it reached the gallbladder; the guide wire was coiled within the gallbladder (●" Fig. 2). Three biliary dilation catheters (6 Fr, 7 Fr, and 9 Fr; Soehendra Transgastric endoscopic ultrasound (EUS)-guided gallbladder drainage for acute cholecystitis