Endoscopic Ultrasound‐Guided Gallbladder Drainage as a Bridge to Surgery for Acute Cholecystitis: A Comparative Study

ABSTRACT Objectives Gallbladder drainage is used for patients with acute cholecystitis (AC) who are unsuitable for emergency cholecystectomy. Percutaneous transhepatic gallbladder drainage (PTGBD), endoscopic ultrasound‐guided gallbladder drainage (EUS‐GBD), and endoscopic transpapillary GBD (ETGBD) are used as bridge‐to‐surgery (BTS) approaches, but comparative data are limited. We compared clinical and perioperative outcomes among these strategies. Methods This retrospective, single‐center study included 84 patients with AC who underwent GBD between January 2016 and January 2026 (PTGBD, n = 26; EUS‐GBD, n = 39; ETGBD, n = 19). The primary endpoint was technical success. Secondary endpoints included clinical success, adverse events, recurrent cholecystitis, hospital stay, and surgical outcomes after BTS. Results Technical success rates were 100% in the PTGBD and EUS‐GBD groups and 73.7% in the ETGBD group ( p < 0.001). Clinical success rates were 92.3%, 100%, and 85.7%, respectively. Recurrent cholecystitis occurred in 7.7% of PTGBD cases and 14.3% of ETGBD cases, but not in EUS‐GBD cases. Median hospital stay was the shortest in the EUS‐GBD group (7 vs. 13.5 days for PTGBD and 9 days for ETGBD; p < 0.001). Among patients who proceeded to surgery, laparoscopic cholecystectomy was performed in 100%, 87.5%, and 75.0% of the EUS‐GBD, PTGBD, and ETGBD groups, respectively ( p = 0.041). Conclusions All three approaches were feasible BTS strategies for AC. EUS‐GBD achieved high technical and clinical success with acceptable safety. After successful BTS, surgical outcomes were broadly comparable among groups. Drainage strategy should be individualized based on patient conditions, anatomical feasibility, and circumstances. Trial Registration : N/A.