Feasibility and safety of endoscopic ultrasound-guided gallbladder drainage for Niemeier type II acute perforated cholecystitis: A multicenter retrospective pilot study

Background Acute perforated cholecystitis (APC) requires timely intervention, and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged as a minimally invasive option for high-risk surgical candidates. This multicenter study evaluated the feasibility and safety of EUS-GBD in patients with Niemeier type II APC. Methods Patients with type II APC who underwent EUSGBD between January 2017 and December 2024 at five tertiary centers were retrospectively analyzed. The primary outcome was technical success; secondary outcomes included clinical success, adverse events, stent patency, and 30- and 90-day all-cause mortality. Results 22 patients with radiologically confirmed type II APC were included. Technical and clinical success were achieved in all patients. Three adverse events occurred: biloma, stent migration, and stent occlusion with recurrent acute cholecystitis. No 30-day mortality occurred; one patient died from pneumonia within 90 days. During a median follow-up of 350 days (interquartile range [IQR] 240-448), Kaplan-Meier stent patency remained at 90.9% and the median patency time was 327 days (IQR 203-413). Conclusions EUS-GBD appeared feasible and safe for highrisk patients with type II APC, achieving high technical and clinical success with a low rate of adverse events.