Endoscopic Ultrasound-Guided Gallbladder Drainage for Acute Cholecystitis in Billroth II Anatomy via Afferent Limb

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an alternative treatment of acute cholecystitis, though there is limited literature on its use in surgically altered anatomy. A 64-year-old woman with gastric adenocarcinoma and Billroth II reconstruction presented with clinical signs and symptoms of acute cholecystitis, cholestatic liver function tests, and an hepatobiliary iminodiacetic acid scan supporting the diagnosis of acute calculous cholecystitis. She was deemed a nonsurgical candidate due to medical comorbidities; therefore, EUS-GBD was pursued. Our case highlights technical modifications to EUS-GBD to navigate challenges in Billroth II anatomy and supports the addition of this technique for high-risk surgical patients.