Cholecystohepaticogastrostomy: novel endoscopic gallbladder drainage technique to prevent acute cholecystitis following endoscopic ultrasound-guided biliary drainage

Cholecystohepaticogastrostomy: novel endoscopic gallbladder drainage technique to prevent acute cholecystitis following endoscopic ultrasound-guided biliary drainageFor malignant distal biliary obstruction (DBO), placing a stent in an antegrade manner across the obstruction and papilla, followed by endoscopic ultrasoundguided hepaticogastrostomy (EUS-HGS), establishes dual biliary drainage pathways and may prolong stent patency [1].However, acute cholecystitis can occur after biliary drainage with a fully covered self-expandable metal stent (FCSEMS) in cases of DBO [2].We present a novel endoscopic approach for gallbladder drainage via the HGS tract, offering a viable option for high-risk patients who develop acute cholecystitis following FCSEMS placement.A 72-year-old woman with advanced pancreatic adenocarcinoma presented with fever, chills, and hyperbilirubinemia.She had previously undergone EUS-guided gastrojejunostomy for gastric outlet obstruction and EUS-HGS for DBO 1 month prior.Imaging revealed dilated intrahepatic ducts and common bile duct, as