Abstract
<title>Abstract</title> <p> Objectives: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) for acute cholecystitis (AC) has a high technical and clinical success rate and is beneficial for patients’ quality of life due to internal fistula drainage, especially for high-risk surgical patients. Two drainage devices (plastic stent [PS] and lumen-apposing metal stent [LAMS]) are available; however, suitable drainage devices remain unclear. Methods: Between 2016 and 2026, 20 PS and 20 LAMS placement high-risk surgical AC were compared. Technical and clinical success rates, the number of dilation cases for the puncture route, procedure time, adverse events (AEs), and hospital stay were evaluated. Results: There was no significant difference in patients’ backgrounds, except for the number of percutaneous gallbladder drainage conversion cases (75% in PS group vs. 10% in LAMS group; <italic>P</italic> < 0.01). The shortest gallbladder diameter tended to be larger in the LAMS (30-mm) than in the PS group (25-mm; <italic>P</italic> = 0.052). Dilation of the puncture site was required in all PS cases. The technical and clinical success rates were 100% in both groups. EUS-GBD procedure time was significantly shorter in the LAMS group (7 min. vs. 21 min.; <italic>P</italic> < 0.01). The AEs occurrence rate was significantly higher in the PS group (40% vs. 5%; <italic>P</italic> = 0.02), which led to a significantly longer hospital stay in PS group (34-days vs. 10-days; <italic>P</italic> = 0.047). Conclusions: LAMS placement in EUS-GBD for high-risk surgical patients with AC was associated with a significantly shorter procedure time, shorter hospital stay, and lower occurrence of AEs. LAMS is a safe and useful device for EUS-GBD. Clinical Trial Registration UMIN000060137 </p>