Single-Session Endoscopic Ultrasound–Directed Transgastric Endoscopic Retrograde Cholangiopancreatography and Simultaneous Endoscopic Ultrasound–Guided Transmural Gallbladder Drainage in Choledocholithiasis and Acute Cholecystitis After Unsuccessful

In patients considered high risk of laparoscopic cholecystectomy, percutaneous gallbladder drainage is traditionally considered first-line treatment option. Recent evidence supports endoscopic gallbladder drainage as a safe and feasible alternate option. We describe a case of Roux-en-Y gastric bypass surgery patient with acute cholecystitis and choledocholithiasis with unsuccessful laparoscopic cholecystectomy because of difficult operative field, underwent successful single-session endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography and endoscopic ultrasound-guided transmural gallbladder drainage at our institution.