{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T13:24:35Z","timestamp":1786973075435,"version":"build-2736575974"},"reference-count":30,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T00:00:00Z","timestamp":1786838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Acute cholecystitis in patients with malignant biliary obstruction (MBO) is challenging to manage. Evidence for endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using double-pigtail plastic stents (DPPS) in this setting remains limited. We evaluated the efficacy and safety of EUS-GBD using DPPS for acute cholecystitis in patients with MBO. Methods: We retrospectively reviewed 41 consecutive patients who underwent EUS-GBD using DPPS at two centers. The primary endpoint was technical success; secondary endpoints included clinical success, adverse events, recurrence, and subsequent oncologic treatment. Results: Technical success was achieved in 95.1% (39\/41), with clinical success in all technically successful cases. Adverse events included biliary peritonitis (14.6%) and procedure-related DPPS migration (2.4%). Recurrence occurred in 2.6% of patients. Systemic therapy was resumed in 10 of 18 patients (55.6%) at a median of 15 days after EUS-GBD. Conclusions: EUS-GBD using DPPS achieved high technical and clinical success rates with a low recurrence rate in selected patients with acute cholecystitis and MBO. Systemic therapy could be resumed in a subset of patients following successful drainage. These findings suggest that DPPS-based EUS-GBD may be a feasible internal drainage option in this setting, although prospective comparative studies are needed to further establish its safety and effectiveness.<\/jats:p>","DOI":"10.3390\/jcm15166329","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:01:26Z","timestamp":1786968086000},"page":"6329","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic Ultrasound-Guided Gallbladder Drainage Using Double-Pigtail Plastic Stents for Acute Cholecystitis in Patients with Malignant Biliary Obstruction"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9169-5574","authenticated-orcid":false,"given":"Keiki","family":"Nagai","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama, Kanagawa 236-0004, Japan"},{"name":"Department of Hepato-Biliary-Pancreatic Medicine, NTT Medical Center Tokyo, Tokyo 141-8625, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2482-6707","authenticated-orcid":false,"given":"Yusuke","family":"Kurita","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama, Kanagawa 236-0004, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3297-3520","authenticated-orcid":false,"given":"Yuji","family":"Fujita","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatic Medicine, NTT Medical Center Tokyo, Tokyo 141-8625, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kensuke","family":"Kubota","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama, Kanagawa 236-0004, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2953-2142","authenticated-orcid":false,"given":"Tomoki","family":"Ogata","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama, Kanagawa 236-0004, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etsuko","family":"Yamabe","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatic Medicine, NTT Medical Center Tokyo, Tokyo 141-8625, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3441-3598","authenticated-orcid":false,"given":"Hiroki","family":"Uechi","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatic Medicine, NTT Medical Center Tokyo, Tokyo 141-8625, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Koyama","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatic Medicine, NTT Medical Center Tokyo, Tokyo 141-8625, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shintaro","family":"Tsujikawa","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatic Medicine, NTT Medical Center Tokyo, Tokyo 141-8625, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Honda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama, Kanagawa 236-0004, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Oda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama, Kanagawa 236-0004, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2230-0333","authenticated-orcid":false,"given":"Takeshi","family":"Iizuka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama, Kanagawa 236-0004, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shin","family":"Yagi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama, Kanagawa 236-0004, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eisuke","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama, Kanagawa 236-0004, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seitaro","family":"Tsujino","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama, Kanagawa 236-0004, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Ishii","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama, Kanagawa 236-0004, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sho","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama, Kanagawa 236-0004, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4785-5543","authenticated-orcid":false,"given":"Shingo","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama, Kanagawa 236-0004, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7815-549X","authenticated-orcid":false,"given":"Masato","family":"Yoneda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama, Kanagawa 236-0004, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1002\/jhbp.516","article-title":"Tokyo Guidelines 2018: Flowchart for the management of acute cholecystitis","volume":"25","author":"Okamoto","year":"2018","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1002\/ags3.12902","article-title":"Palliative management for malignant biliary obstruction and gastric outlet obstruction from pancreatic cancer","volume":"9","author":"Wu","year":"2025","journal-title":"Ann. Gastroenterol. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1016\/j.cgh.2006.06.004","article-title":"Cholecystitis after metallic stent placement in patients with malignant distal biliary obstruction","volume":"4","author":"Isayama","year":"2006","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.gie.2024.02.019","article-title":"Risk factors and treatment strategies for cholecystitis after metallic stent placement for malignant biliary obstruction: A multicenter retrospective study","volume":"100","author":"Matsumi","year":"2024","journal-title":"Gastrointest. Endosc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1016\/j.gie.2024.03.027","article-title":"American Society for Gastrointestinal Endoscopy guideline on the role of therapeutic EUS in the management of biliary tract disorders: Summary and recommendations","volume":"100","author":"Pawa","year":"2024","journal-title":"Gastrointest. Endosc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"40","DOI":"10.5946\/ce.2023.294","article-title":"Endoscopic biliary drainage for distal bile duct obstruction due to pancreatic cancer","volume":"58","author":"Itonaga","year":"2025","journal-title":"Clin. Endosc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"17562848241299755","DOI":"10.1177\/17562848241299755","article-title":"A review of endoscopic ultrasound-guided gallbladder drainage and gastroenterostomy: Assisted approaches and comparison with alternative techniques","volume":"17","author":"Xu","year":"2024","journal-title":"Ther. Adv. Gastroenterol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Binda, C., Anderloni, A., Forti, E., Fusaroli, P., Macchiarelli, R., Manno, M., Fugazza, A., Redaelli, A., Aragona, G., and Lovera, M. (2024). EUS-guided gallbladder drainage using a lumen-apposing metal stent for acute cholecystitis: Results of a nationwide study with long-term follow-up. Diagnostics, 14.","DOI":"10.3390\/diagnostics14040413"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1016\/j.gie.2015.05.045","article-title":"EUS-guided gallbladder drainage with a lumen-apposing metal stent (with video)","volume":"82","author":"Irani","year":"2015","journal-title":"Gastrointest. Endosc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"411","DOI":"10.5946\/ce.2015.48.5.411","article-title":"Endoscopic gallbladder drainage for acute cholecystitis","volume":"48","author":"Widmer","year":"2015","journal-title":"Clin. Endosc."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Harada, K., Miyamoto, K., Matsumoto, K., Morimoto, K., Ueta, E., Akimoto, Y., Hattori, N., Obata, T., Sato, R., and Matsumi, A. (2026). Long-term outcomes of endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis in non-surgical candidates: A multicenter retrospective study. J. Clin. Med., 15.","DOI":"10.3390\/jcm15103621"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"262","DOI":"10.5946\/ce.2018.183","article-title":"Endoscopic ultrasonography-guided gallbladder drainage as a treatment option for acute cholecystitis after metal stent placement in malignant biliary strictures","volume":"52","author":"Kozakai","year":"2019","journal-title":"Clin. Endosc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1016\/0895-4356(94)90129-5","article-title":"Validation of a combined comorbidity index","volume":"47","author":"Charlson","year":"1994","journal-title":"J. Clin. Epidemiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.5152\/tjg.2019.181032","article-title":"Technical issues stemming from endoscopic-ultrasound-guided gallbladder drainage: A single center experience","volume":"30","author":"Kanno","year":"2019","journal-title":"Turk. J. Gastroenterol."},{"key":"ref_15","first-page":"393","article-title":"Long-term results of percutaneous cholecystostomy for definitive treatment of acute acalculous cholecystitis: A 10-year single-center experience","volume":"81","author":"Ozyer","year":"2018","journal-title":"Acta Gastroenterol. Belg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1016\/j.gie.2021.11.038","article-title":"Novel classification for adverse events in GI endoscopy: The AGREE classification","volume":"95","author":"Nass","year":"2022","journal-title":"Gastrointest. Endosc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1055\/a-0929-6603","article-title":"Endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for high risk surgical patients with acute cholecystitis: A systematic review and meta-analysis","volume":"51","author":"Luk","year":"2019","journal-title":"Endoscopy"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1055\/a-1020-3932","article-title":"Endoscopic ultrasound-guided gallbladder drainage, transpapillary drainage, or percutaneous drainage in high risk acute cholecystitis patients: A systematic review and comparative meta-analysis","volume":"52","author":"Mohan","year":"2020","journal-title":"Endoscopy"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1055\/s-0034-1365720","article-title":"Long-term outcomes after endoscopic ultrasonography-guided gallbladder drainage for acute cholecystitis","volume":"46","author":"Choi","year":"2014","journal-title":"Endoscopy"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1016\/j.cgh.2016.12.021","article-title":"Similar efficacies of endoscopic ultrasound gallbladder drainage with a lumen-apposing metal stent versus percutaneous transhepatic gallbladder drainage for acute cholecystitis","volume":"15","author":"Irani","year":"2017","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1016\/j.cgh.2025.08.028","article-title":"Rethinking endoscopic ultrasound-guided choledochoduodenostomy with lumen-apposing metal stent: The indication matters as much as the stent","volume":"24","author":"Facciorusso","year":"2026","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"661","DOI":"10.3748\/wjg.v23.i4.661","article-title":"Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent","volume":"23","author":"Kamata","year":"2017","journal-title":"World J. Gastroenterol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1821","DOI":"10.1111\/jgh.15065","article-title":"Endoscopic ultrasound-guided gallbladder drainage with a combined internal and external drainage tubes for acute cholecystitis","volume":"35","author":"Matsubara","year":"2020","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1007\/s00534-010-0310-4","article-title":"Endoscopic ultrasonography-guided gallbladder drainage: Actual technical presentations and review of the literature (with videos)","volume":"18","author":"Itoi","year":"2011","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1111\/den.14710","article-title":"Simple endoscopic ultrasound-guided gallbladder aspiration\/irrigation using a double-pigtail plastic stent system","volume":"36","author":"Ban","year":"2024","journal-title":"Dig. Endosc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"E227","DOI":"10.1055\/a-2786-0666","article-title":"Removal of an intra-gallbladder migrated lumen apposing metal stent through a secondary endoscopic ultrasound-guided gallbladder drainage","volume":"58","author":"Altieri","year":"2026","journal-title":"Endoscopy"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.vgie.2021.10.002","article-title":"EUS-guided gallbladder drainage and subsequent peroral endoscopic cholecystolithotomy: A tool to reduce chemotherapy discontinuation in neoplastic patients?","volume":"7","author":"Vanella","year":"2022","journal-title":"VideoGIE"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1111\/j.1477-2574.2012.00610.x","article-title":"Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: A multicentre analysis","volume":"15","author":"Sanjay","year":"2013","journal-title":"HPB"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Ishii, K., Fujita, Y., Suzuki, E., Koyama, Y., Tsujino, S., Nagao, A., Hosono, K., Teratani, T., Kubota, K., and Nakajima, A. (2023). The efficacy and safety of EUS-guided gallbladder drainage as a bridge to surgery for patients with acute cholecystitis. J. Clin. Med., 12.","DOI":"10.3390\/jcm12082778"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e70199","DOI":"10.1111\/den.70199","article-title":"EUS-guided gallbladder drainage in acute cholecystitis with contained perforation: An international multicenter study","volume":"38","author":"Spadaccini","year":"2026","journal-title":"Dig. Endosc."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6329\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:27:06Z","timestamp":1786969626000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6329"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,16]]},"references-count":30,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166329"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166329","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,16]]}}}