Endoscopic Ultrasound-Guided Gallbladder Drainage Using a 19-Gauge Needle and a Modified Slim Metal Stent: A Simplified Approach (With Video)

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is a promising therapeutic option for surgically unfit patients with acute cholecystitis. Data on the use of fully covered self-expandable metal stents (FCSEMSs) in this setting remain limited, especially in the cancer population. We describe a simplified needle-to-stent EUS-GBD technique and report its early clinical outcomes using a 19-gauge Franseen-tip FNB needle and a modified slim FCSEMS. We applied this technique in consecutive patients with acute cholecystitis secondary to malignant biliary obstruction between September 2022 and September 2025. Early outcomes were technical and clinical success, adverse events, and 30-day mortality. Eighteen patients were included. The median gallbladder size was 90 mm, and the wall-to-lumen puncture distance was 15 mm. The first part of the duodenum was the main access route (88.9%). Both technical and clinical success rates were 100%. Over a median follow-up of 6 months, one patient (5.6%) developed recurrent cholecystitis, which was successfully treated endoscopically. No severe adverse event or 30-day mortality occurred. This technique is both feasible and safe.