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 EUS-GBD 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 high-risk patients with type II APC, achieving high technical and clinical success with a low rate of adverse events.