Randomized Trial of Percutaneous vs. Endoscopic Gallbladder Drainage

Inclusion Criteria:

* Patients with suspected or confirmed acute calculous cholecystitis, diagnosed per Tokyo guidelines
* Age ≥ 18 years
* Patients due to severe comorbidity who are deemed to be never-surgery candidates by the multidisciplinary team or patients who refuse to undergo surgery.
* Patients can undergo EUS-guided drainage and percutaneous cholecystostomy tube placement.
* Written informed consent by the patient or guardian who can understand the nature and possible consequences of participation in the study.

Exclusion Criteria:

* Pregnancy
* Patients who are potential candidates for future cholecystectomy.
* Patients unwilling to undergo follow-up assessments.
* Patients with suspected gangrene or perforation of the gallbladder
* Patients are diagnosed with concomitant liver abscess or necrotizing pancreatitis.
* Altered anatomy of the upper gastrointestinal tract due to surgery of the esophagus, stomach and duodenum.
* Indwelling percutaneous cholecystostomy tube.
* Refractory/persistently significant ascites despite paracentesis.
* Distance between the gallbladder and gastric/duodenal wall that cannot be bridged by the metal stent.
* Abnormal coagulation parameters that cannot be correct: INR \> 1.7 and/or platelets \< 50.000/mm3