Endoscopic Naso-gallbladder Drainage Research Articles

Endoscopic Internalization by Cutting the Endoscopic Transpapillary Nasogallbladder Drainage Tube in Management of Acute Cholecystitis: A Retrospective Multicenter Cohort Study.

Both endoscopic nasogallbladder drainage (ENGBD) and endoscopic gallbladder stenting (EGBS) are effective management for acute cholecystitis, although ENGBD can cause discomfort due to its nature of external drainage. Converting ENGBD to EGBS after improvement of cholecystitis might be one treatment strategy. The drainage tube of ENGBD could be endoscopically cut inside the stomach to convert to internal drainage without additional endoscopic retrograde cholangiography (ERCP). To evaluate the feasibility, efficacy and safety of endoscopic internalization by cutting an ENGBD tube for acute cholecystitis. Twenty-one patients who underwent endoscopic internalization by cutting the ENGBD tube were enrolled in this study. We initially placed an ENGBD tube for gallbladder lavage and continuous drainage. After improvement of cholecystitis, the tube was cut in the stomach by esophagogastroduodenoscopy (EGD) and placed as EGBS until surgery. The technical success rate of this procedure was 90.5% (19/21), and the clinical success rate was 100% (19/19). The median procedural time was 5 min (range: 2-14 min). Procedural-related adverse events (AEs) were observed in two patients where the tip of the ENGBD tube migrated into the common bile duct from the gallbladder during the procedure in both. During the waiting period for elective surgery, no AEs were identified, except for stent migration without symptoms in one patient (4.7%). Endoscopic internalization by cutting the ENGBD tube after improvement of cholecystitis could be an effective and safe treatment option for preventing recurrent cholecystitis in the waiting period until cholecystectomy.

Endoscopic treatment including a single-operator peroral cholangioscopy-guided electrohydraulic lithotripsy and endoscopic nasogallbladder drainage combined laparoscopic cholecystectomy for Mirizzi syndrome

Mirizzi Syndrome (MS) is rare among gallbladder diseases and may be difficult to treat. In particular, endoscopic treatment often fails owing to unable to access or capture the impacted cystic duct stone. We report a case of MS grade III that were successfully managed by an endoscopic treatment and interval laparoscopic cholecystectomy. A 59-year-old women was admitted our hospital presenting with upper abdominal pain and fever up to 38.5℃. She was mildly jaundiced with scleral icterus with a positive Murphy's sign. An abdomen computed tomography scan and T2-weight magnetic resonance cholangiopancreatography image demonstrated about 1.4cm stone at junction of the cystic duct and mid-common bile duct with cholecysto-choledochal fistula, compatible with MS type III and acute calculus cholecystitis. A digital single-operator cholangioscopy (DSOC)-guided eletrohydraulic lithotripsy (EHL) was performed. Elective laparoscopic cholecystectomy was performed after the stones were completely removed. The patient was discharged without any complications on the 5th day after surgery. The treatment of MS is mainly surgical and consists of partial or complete cholecystectomy with or without common bile duct exploration. However, in the era of minimal invasive treatment, laparoscopy treatment for low grade MS is being tried steadily. In our case, through preoperative intervention using DSOC guided EHL, the effect of downgrading MS could be achieved, and this resulted in a safe laparoscopic surgical approach. In conclusion, DSOC guided EHL with ENGBD may allow a minimally invasive approach for management of high grade MS.

Permanent endoscopic gallbladder stenting versus removal of gallbladder drainage, long-term outcomes after management of acute cholecystitis in high-risk surgical patients for cholecystectomy: Multi-center retrospective cohort study.

Endoscopic transpapillary gallbladder drainage (EGBD) has been reported as an effective gallbladder drainage treatment option for acute cholecystitis in high-risk surgical patients. However, the long-term outcomes such as cholecystitis' recurrence rate after placement of EGB stenting (EGBS) have not been well studied yet. The aim of the present study was to compare the long-term outcome of EGBS and removal of gallbladder drainage after percutaneous transhepatic gallbladder drainage (PTGBD) or endoscopic nasogallbladder drainage (ENGBD) for acute cholecystitis in high-risk surgical patients and clarify the usefulness of long-term placement of EGBS. We retrospectively studied 180 high-risk surgical patients with acute cholecystitis between January 2010 and December 2018. The patients were divided into two groups: EGBS group (long-term placement of EGBS) or Removal group (removal of drainage tube after PTGBD or ENGBD). Clinical outcomes, including long-term results, were compared between the groups. The cumulative late adverse event (AE) rates were 5.0% and 22.1% in the EGBS and Removal group (P=.002), with a median follow-up period of 375 and 307days in the two groups, respectively. The cumulative cholecystitis recurrence rate was 5.0% (2/40) in the EGBS group and 16% (21/131) in the Removal group (P=.024), respectively. In the multivariate analysis for late AE, only EGBS was an independent risk factor with a decreasing value. The permanent EGBS in high-risk surgical patients with acute cholecystitis was considered effective in reducing the risk of late AE.

The Evaluation of ENGBD Versus PTGBD in High Risk Acute Cholecystitis: A Single-Center Prospective Randomized Controlled Trial

Background: Gallbladder drainage plays a key role in the management of high-risk patients with acute cholecystitis. Percutaneous transhepatic gallbladder drainage (PTGBD) is a common drainage method, and endoscopic naso-gallbladder drainage (ENGBD) is an alternative natural orifice transluminal endoscopic procedure. No study has clearly declared the better method or their impact on subsequent cholecystectomy. Methods: We performed an open-label, prospective randomized controlled parallel trial at a tertiary surgical center. Patients who needed gallbladder decompression were randomly assigned to receive ENGBD or PTGBD. The primary endpoint was the abdominal pain score, and the intention-to-treat population was analyzed. Findings: Twenty-two participants were enrolled, and the abdominal pain scores of the ENGBD group before drainage and 24, 48, and 72 hours after drainage were 6.0 (6.0-8.0), 4.0 (3.0-6.0), 2.0 (2.0-2.0) and 1.0 (1.0-2.0), respectively, while those of the PTGBD group were 7.0 (6.0-9.0), 6.0 (6.0-7.0), 5.0 (4.0-6.0) and 3.0 (3.0-5.0), respectively. The abdominal pain scores were significantly lower in the ENGBD group, as were the gallbladder area tenderness score(P <0.05). ENGBD was associated with significantly fewer hemorrhages and abdominal drainage tubes than PTGBD (15 [5-20] vs 40 [20-70] ml, 3 vs 9, P <0.05), and a significant difference in the grade and lymphocyte count of gallbladder pathology was observed (P <0.05). Interpretation: ENGBD and PTGBD were equivalent in terms of technical success, clinical effectiveness, and safety. ENGBD was associated with less pain, certain advantages in gallbladder pathology and fewer difficulties from cholecystectomy. Trial Registration Number: Registered at http://www.clinicaltrial.gov under trial identification number NCT03701464. Funding: This work was supported by National Natural Science Foundation of China (NO.31570509). There was no commercial support. Conflict of Interest: No conflict of interest was declared by the authors. Ethical Approval: The ethics committee of the hospital center approved the study, which was performed in accordance with a published protocol.

Minimally Invasive Approach Using Digital Single-Operator Peroral Cholangioscopy-Guided Electrohydraulic Lithotripsy and Endoscopic Nasogallbladder Drainage for the Management of High-Grade Mirizzi Syndrome

Mirizzi syndrome is a rare complication of gallbladder disease that can be difficult to treat. In particular, endoscopic treatment often fails because of the inability to access or to capture the impacted cystic duct stone. We report a case of Mirizzi syndrome grade III that was successfully managed by digital single-operator peroral cholangioscopy-guided electrohydraulic lithotripsy with endoscopic nasogallbladder drainage and interval laparoscopic cholecystectomy. Based on our experience, digital single-operator peroral cholangioscopy-guided electrohydraulic lithotripsy with endoscopic nasogallbladder drainage is a feasible minimally invasive approach for the management of high-grade Mirizzi syndrome.

Management of acute cholecystitis in patient with cyclic neutropenia: a case report

BackgroundCyclic neutropenia is a disease that causes a neutropenic decrease in peripheral blood in a cycle of about 21 days. It is a rare hereditary disorder with an estimated incidence of 0.5–1 cases per million population. The absolute neutrophil count can drop to zero, and neutropenic nadir may last for 3–5 days. This is a rare disease, and there are few reports of abdominal surgery in cyclic neutropenia patients; thus, we report this case of neutrophil count fluctuation and perioperative management.Case presentationA 31-year-old man with cyclic neutropenia was transferred to our hospital complaining of right season rib pain, but no rebound tenderness. His C-reactive protein was elevated (4.37 mg/L) and computed tomography revealed a large number of small stones in the gallbladder body and an incarceration in the gallbladder neck. He was diagnosed with acute cholecystitis. Ideally, surgical intervention should have been performed immediately, but because his neutrophil count was 300/μL, endoscopic naso-gallbladder drainage was performed and he was provided antibiotics until his neutrophil count increased to acceptable levels. Three days after admission, his neutrophil count had increased and laparoscopic cholecystectomy was performed. For one week after the operation, antibiotics were administered; he had an uneventful postoperative recovery. He was discharged on the seventh postoperative day and provided an oral antibiotic.ConclusionsInfection can be serious in patients with cyclic neutropenia, and it is therefore, important to determine the timing of surgery and to apply appropriate perioperative management with drainage and antibiotic administration.

The evaluation of ENGBD versus PTGBD in high-risk acute cholecystitis: A single-center prospective randomized controlled trial.

BackgroundGallbladder drainage plays a key role in the management of acute cholecystitis (AC) patients. Percutaneous transhepatic gallbladder drainage (PTGBD) is commonly used while endoscopic naso-gallbladder drainage (ENGBD) serves as an alternative.MethodsA single center, prospective randomized controlled trial was performed. Eligible AC patients were randomly assigned to ENGBD or PTGBD group. Randomization was a computer-generated list with 1:1 allocation. All patients received cholecystectomy 2–3 months after drainage. The primary endpoint was abdominal pain score, and the intention-to-treat population was analyzed. (ClinicalTrials.gov: NCT03701464).FindingsBetween Oct 1, 2018 and Feb 29, 2020, 22 out of 61 consecutive AC patients were enrolled in the final analysis. The mean abdominal pain scores before drainage, and at 24, 48, and 72 h after drainage in ENGBD were 6.9 ± 1.1, 4.3 ± 1.2, 2.2 ± 0.8 and 1.5 ± 0.5, respectively, while those of PTGBD were 7.4 ± 1.2, 6.2 ± 1.2, 5.3 ± 1.0 and 3.7 ± 0.9; and the mean gallbladder area tenderness scores were 8.4 ± 1.2, 5.7 ± 0.9, 3.5 ± 0.7, 2.5 ± 0.5 for ENGBD and 8.6 ± 0.9, 7.3 ± 1.0, 7.4 ± 0.5, 4.8 ± 0.9 for PTGBD. The mean abdominal pain and gallbladder area tenderness scores of the ENGBD significantly decreased than the PTGBD (group × time interaction P<0.001, respectively). ENGBD group presented lower post-operative hemorrhage and abdominal drainage tube placement rates (median (IQR) 15[5–20] vs 40[20–70]ml, 3vs9, P = 0.03), and pathological grade and lymphocyte count were observed (P = 0.004) between groups. No adverse events were observed in 3 months follow-up.InterpretationCompared to PTGBD, ENGBD group presented less pain, better gallbladder pathological grades and less surgical difficulties during cholecystectomy procedures.FundingNational Natural Science Foundation of China (82060551).

Endoscopic transpapillary gallbladder drainage for the management of acute calculus cholecystitis patients unfit for urgent cholecystectomy.

Endoscopic transpapillary gallbladder drainage (ETGBD) has been proposed as an alternative to surgery or percutaneous cholecystostomy in patients with acute calculus cholecystitis (ACC). We aimed to evaluate the safety and efficacy of ETGBD via endoscopic transpapillary gallbladder stenting (ETGBS) or endoscopic naso-gallbladder drainage (ENGBD) as either a bridging or a definitive treatment option for patients with ACC when a cholecystectomy is delayed or cannot be performed. From July 2014 to December 2018, 171 patients with ACC in whom ETGBD were attempted were retrospectively reviewed. The technical and clinical success rates and adverse events were evaluated. Moreover, the predictive factors for technical success and the stent patency in the ETGBS group with high surgical risk were examined. The technical and clinical success rates by intention-to-treat analysis for ETGBD were 90.6% (155/171) and 90.1% (154/171), respectively. Visible cystic duct on cholangiography were significant technical success predictor (adjusted odds ratio: 7.099, 95% confidence interval: 1.983-25.407, P = 0.003) as per logistic regression analysis. Adverse events occurred in 12.2% of patients (21/171: mild pancreatitis, n = 9; acute cholangitis, n = 6; post-endoscopic sphincterotomy bleeding, n = 4; and stent migration, n = 1; ACC recurrence, n = 1), but all patients were treated with conservative management and endoscopic treatment. Among the ETGBS group, the median stent patency in 70 patients with high surgical risk was 503 days (interquartile range: 404.25-775 days). ETGBD, using either ETGBS or ENGBD, may be a suitable bridging option for ACC patients unfit for urgent cholecystectomy. In high surgical risk patients, ETGBS may be a promising and useful treatment modality with low ACC recurrence.

Factors affecting technical success of endoscopic transpapillary gallbladder drainage for acute cholecystitis.

Endoscopic transpapillary gallbladder drainage (ETGBD), including endoscopic nasogallbladder drainage (ENGBD) and endoscopic gallbladder stenting (EGBS), has been reported to be an effective treatment for acute cholecystitis. However, ETGBD is considered to be more difficult than percutaneous transhepatic gallbladder drainage (PTGBD), and few studies have evaluated the factors that affect technical success of the procedure. We investigated the factors predicting its technical success from among patient characteristics and image findings before treatment. Three hundred twenty three patients who underwent ETGBD for acute cholecystitis from November 2006 to December 2018 were analyzed retrospectively. The technical success rate was 72.8% (235/323). The technical success rate by cystic duct direction was as follows: proximal/distal, 65.9%/93.6%; right/left: 74.0%/65.2%; cranial/caudal, 83.5%/20.0%. The clinical response rate was 96.2% (226/235). Adverse events were encountered in 5.9% of cases (19/323), including cystic duct injury (11 patients), pancreatitis (five patients), and bleeding (three patients). In both univariate and multivariate analysis, presence of cystic duct stone, dilation of the common bile duct (CBD), and cystic duct direction (proximal and caudal branches) were identified as significant factors affecting technical failure of ETGBD. Although ETGBD was an effective and safe procedure for acute cholecystitis, it has a limited success rate. The presence of cystic duct stone, dilation of CBD, and cystic duct direction (proximal and caudal branches) can serve as important predictors of ETGBD difficulties. These findings should be considered before procedures and the necessary adaptation of ETGBD made.

Endoscopic Nasogallbladder Drainage Combined with Laparoscopic Surgery for Type I Mirizzi Syndrome with Acute Cholecystitis: A Case Series Report.

Objective To investigate the safety and feasibility of endoscopic nasogallbladder drainage (ENGBD) combined with laparoscopic surgery for Mirizzi syndrome type I with acute cholecystitis. Methods An analysis of 4 patients with type I Mirizzi syndrome with acute cholecystitis admitted to the First Hospital of Jilin University. Results The patients underwent ENGBD, and laparoscopic surgery was evaluated postoperatively. All four patients successfully recovered from this combined surgical approach. Conclusion The combination of ENGBD and laparoscopic surgery is safe and feasible for the treatment of patients with type I Mirizzi syndrome accompanied by acute cholecystitis. This approach may reduce the traumatic stress on patients and is worthy of widespread implementation.

Endoscopic Transpapillary Gallbladder Stenting for Acute Cholecystitis in a Patient with Metastatic Pancreatic Cancer

Percutaneous transhepatic gallbladder drainage is an effective treatment for acute cholecystitis in poor surgical candidates. Endoscopic gallbladder drainage procedures, such as endoscopic ultrasound-guided gallbladder drainage, endoscopic gallbladder stenting, and endoscopic naso-gallbladder drainage, have been used as alternative treatments for acute cholecystitis. These procedures are associated with increased patient comfort and physiologic drainage. We report a case of endoscopic gallbladder stenting for acute cholecystitis in a 62-year-old male undergoing chemotherapy for metastatic pancreatic cancer. After endoscopic gallbladder stenting, the patient’s acute cholecystitis resolved and he was able to undergo scheduled chemotherapy. The inserted double-pigtail plastic stent will be left in situ permanently. The choice of drainage modality for acute cholecystitis will generally be based on resources, patient preferences, local expertise, and clinical context.

Endoscopic ultrasound-guided gallbladder drainage: Current status and future prospects.

Early surgical treatment using the laparoscopic approach is generally accepted as the treatment of choice for acute cholecystitis (AC) according to Tokyo Guidelines 2018 (TG2018). If the patient is a poor candidate for surgery because of the presence of advanced malignancy or severe organ failure, this treatment may be too invasive. In such cases, gallbladder drainage is considered an alternative treatment method to surgery. Several drainage methods have been established, such as percutaneous transhepatic gallbladder drainage (PTGBD) or endoscopic transpapillary gallbladder drainage (ETGBD) under endoscopic retrograde cholangiopancreatography (ERCP), including endoscopic naso-gallbladder drainage (ENGBD) and endoscopic gallbladder stenting (EGBS). PTGBD is a well-established procedure that is relatively easily carried out by general clinicians. And ETGBD has been developed as an alternative drainage method. The procedure also calls for guidewire passage across the cystic duct. Therefore, in AC cases who are contraindicated for surgery, PTGBD should be considered before ETGBD, and ETGBD may be considered only in high-volume institutes where expert hands are available, as described in the TG2018. However, there are several limitations to these procedures. Recently, endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is increasingly being done as an alternative method to PTGBD and ETGBD. In this review, the current status and problems of EUS-GBD are reviewed, including technical review and clinical data of previous papers, current indication, long-term outcome, and comparison data with PTGBD or ETGBD, and their future prospects are discussed.

Intracystic papillary neoplasm preoperatively diagnosed by high-quality cytology derived from endoscopic nasogallbladder drainage

Intracystic papillary neoplasm preoperatively diagnosed by high-quality cytology derived from endoscopic nasogallbladder drainage

Feasibility of conversion of percutaneous cholecystostomy to internal transmural endoscopic ultrasound-guided gallbladder drainage.

Background/Aim:Percutaneous cholecystostomy [percutaneous transhepatic gallbladder drainage (PTGBD)] is the treatment of choice in surgically unfit patients with acute cholecystitis. However, PTGBD tube removal after symptoms resolution results in 41–46% recurrence. This study aims to demonstrate the feasibility of the conversion of PTGBD to transmural endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using plastic stents in patients unfit for cholecystectomy.Patients and Methods:Patients who underwent internal transmural EUS-GBD as a conversion from PTGBD were reviewed. EUS-GBD was performed after the improvement of cholecystitis due to recurrent cholecystitis and PTGBD intolerance. One or two 7-Fr double pigtail plastic stent insertion with or without temporary endoscopic naso-gallbladder drainage (ENGBD) insertion was performed.Results:Six patients (age 61–88), with three cases of acute cholecystitis after metallic biliary stenting and three cases of calculus cholecystitis, who underwent PTGBD were included. EUS-GBD was performed 10–63 days after PTGBD, using one plastic stent in five cases, two stents in one case, with temporary ENGBD in two cases. The technical success and clinical success were achieved and the PTGBD tubes were subsequently removed in all patients. All ENGBD tubes were removed within 5 days after insertion. Bile leak with peritonitis was demonstrated in one case, which was treated conservatively. No recurrent cholecystitis was seen during 3–26 months of follow-up.Conclusion:The conversion of percutaneous cholecystostomy to internal transmural EUS-GBD with plastic stents is feasible for patients unfit for cholecystectomy. However, more studies are still needed to confirm the results.

Can Endoscopic Nasobiliary Drainage Involving Two Catheters Be Used to Treat Various Conditions?

Can Endoscopic Nasobiliary Drainage Involving Two Catheters Be Used to Treat Various Conditions?

Endoscopic naso-gallbladder drainage versus gallbladder stenting before cholecystectomy in patients with acute cholecystitis and a high suspicion of choledocholithiasis: a prospective randomised preliminary study

Objective Endoscopic transpapillary gallbladder drainage using a nasocystic tube or plastic stent has been attempted as an alternative to percutaneous drainage for patients with acute cholecystitis who are not candidates for urgent cholecystectomy. We aimed to assess the efficacy of single-step endoscopic drainage of the common bile duct and gallbladder, and to evaluate which endoscopic transpapillary gallbladder drainage method is ideal as a bridge before elective cholecystectomy. Materials and methods From July 2011 to December 2014, 35 patients with acute moderate-to-severe cholecystitis and a suspicion of choledocholithiasis were randomly assigned to the endoscopic naso-gallbladder drainage (ENGBD) (n = 17) or endoscopic gallbladder stenting (EGBS) (n = 18) group. Results Bile duct clearance was performed successfully in all cases. No significant differences were found between the ENGBD and EGBS groups in the technical success rates [82.4% (14/17) vs. 88.9% (16/18), p = 0.658] and clinical success rates [by intention-to-treat analysis: 70.6% (12/17) vs. 83.3% (15/18), p = 0.443; by per protocol analysis of technically feasible cases: 85.7% (12/14) vs. 93.8% (15/16), p = 0.586]. Three ENGBD patients and two EGBS patients experienced adverse events (p = 0.658). No significant differences were found in operation time or rate of conversion to open cholecystectomy. Conclusions Single-step endoscopic transpapillary drainage of the common bile duct and gallbladder seems to be an acceptable therapeutic modality in patients with acute cholecystitis and a suspicion of choledocholithiasis. There were no significant differences in the technical and clinical outcomes between ENGBD and EGBS as a bridge before cholecystectomy.

Endoscopic cutting technique using scissors forceps after temporary endoscopic naso‐gallbladder drainage for acute cholecystitis (with videos)

Endoscopic naso-gallbladder drainage (ENGBD) is useful in acute cholecystitis patients until surgery [1, 2]. However, cholecystectomy may become difficult during treatment owing to patient illness. Although endoscopic transpapillary gallbladder stenting is effective in such patients, technical success is achieved in only 80% of acute cholecystitis cases [3]. We describe a safe cutting technique after temporary ENGBD for acute cholecystitis. A 92-year-old man with acute cholecystitis was admitted to our institution. We continued his anticoagulant therapy from another hospital owing to atrial fibrillation and brain infarction history. As the patient showed good performance status, we planned elective laparoscopic cholecystectomy after local inflammation and general condition improvement by gallbladder drainage. We performed ENGBD using a 6-Fr pigtail-type nasobiliary drainage tube (Olympus Medical Systems, Tokyo, Japan) without sphincterotomy (Fig. 1a,b; Video S1). The procedure was successful without adverse events and the symptoms disappeared. However, after 2 days, brain infarction occurred. Cholecystectomy was deemed inappropriate in the acute phase of brain infarction. Therefore, drainage tube cutting using scissors forceps (FS-5/L-1, Olympus Medical Systems) was performed. A side-viewing endoscope was inserted in the stomach, and the drainage tube was confirmed. The tube was pressed against the gastric wall to fix the position and cut off (Fig. 2a–c; Video S2). The diameter of the 6-Fr drainage tube was relatively large compared with the distance of the fully opened scissors forceps. Therefore, the cutting procedure required three attempts (7 min). Finally, the tube stump

Idiopathic perforation of gallbladder diagnosed by endoscopic nasogallbladder drainage

Idiopathic perforation of gallbladder diagnosed by endoscopic nasogallbladder drainage

A Case with Double Cancers of the Gallbladder and Bile Duct Associated with Pancreatobiliary Maljunction and Detected by the Endoscopic Naso-gallbladder Drainage (ENGBD) Cytology and Transpapillary Biliary Forceps Biopsy

A Case with Double Cancers of the Gallbladder and Bile Duct Associated with Pancreatobiliary Maljunction and Detected by the Endoscopic Naso-gallbladder Drainage (ENGBD) Cytology and Transpapillary Biliary Forceps Biopsy

Endoscopic nasogallbladder tube or stent placement in acute cholecystitis: a preliminary prospective randomized trial in Japan (with videos)

There are currently no prospective, controlled trials of endoscopic transpapillary gallbladder drainage in patients with acute cholecystitis. We evaluated the technical success rate and efficacy of endoscopic transpapillary gallbladder drainage by using either endoscopic nasogallbladder drainage (ENGBD) or endoscopic gallbladder stenting (EGBS) for patients with acute cholecystitis. Randomized, controlled study. Tertiary-care referral centers. Seventy-three consecutive patients with acute cholecystitis were randomized. ENGBD by using a 5F or 7F tube (n= 37) or EGBS (n= 36) by using a 7F stent. Technical success, clinical success, adverse events, and procedure-related pain score. The overall technical success rates in the ENGBD and EGBS groups were 91.9% and 86.1%, respectively (P > .05). The mean procedure times of ENGBD and EGBS were 20.3 ± 12.1 and 22.2 ± 14.5 minutes, respectively (P > .05). The overall clinical success rates by per protocol analysis were 94.1% and 90.3% in the ENGBD and EGBS groups, respectively, whereas the rates by intention-to-treat analysis were 86.5% and 77.8%, respectively (P > .05). Moderate adverse events were observed in the ENGBD (n= 2) and EGBS (n= 1) groups. The mean visual analog score of postprocedure pain in the ENGBD group was significantly higher than that in the EGBS group (1.3 ± 1.1 vs 0.4 ± 0.8, respectively; P< .001). Small sample size and the participation of multiple endoscopists who may have different levels of experience in endoscopic transpapillary gallbladder drainage. Both ENGBD and EGBS appear to be suitable for the treatment of acute cholecystitis in patients who are poor candidates for emergency cholecystectomy. ( UMIN000012316.).