Acute cholecystitis occurs in 4 % – 7 % of patients with a covered metallic stent (CMS) placed in the bile duct [ 1 ] [ 2 ]. Percutaneous transhepatic gallbladder drainage, which involves an external drainage tube, decreases the ability of the patient to carry out their normal daily activities. Recently, endoscopic ultrasound (EUS)-guided drainage has been employed successfully for hepatogastrostomy, bilioduodenostomy, and pancreatogastrostomy [ 3 ] [ 4 ] [ 5 ]. We report here a patient who underwent EUS-guided gallbladder drainage for acute cholecystitis caused by CMS placement. A 71-year-old man with unresectable pancreatic cancer underwent deployment of a CMS for obstructive jaundice. On the eighth post-procedure day, he complained of abdominal pain and developed fever, associated with an increase in white blood cell counts and raised serum level of C-reactive protein. Computed tomography revealed an enlarged gallbladder, suggesting acute cholecystitis and requiring continuous drainage of the gallbladder. Therefore, after obtaining informed consent, we carried out EUS-guided gallbladder drainage. An echoendoscope (GF-UCT240-AL5; Olympus, Tokyo, Japan) was introduced into the stomach, and a 19-gauge needle (Echo-Tip; Wilson-Cook, Winston-Salem, North Carolina, USA) was used to puncture the gallbladder ([ Fig. 1 ]) and create a gastro-gallbladder fistula. The infected bile was immediately aspirated via the needle and the gallbladder was irrigated with a contrast medium containing an antibiotic. A 0.035-inch guide wire (Revowave, Olympus, Tokyo, Japan) was passed through the needle under fluoroscopic guidance until it reached the gallbladder; the guide wire was coiled within the gallbladder ([ Fig. 2 ]). Three biliary dilation catheters (6 Fr, 7 Fr, and 9 Fr; Soehendra Biliary Dilation Catheters, Wilson-Cook, Winston-Salem, North Carolina, USA) were serially advanced over the guide wire to dilate the diameter of the tract. A pigtail stent (diameter 7 Fr; length 4 cm) was placed over the guide wire to bridge the gallbladder and the antrum of the stomach ([ Fig. 3 ], [ 4 ]). There were no procedure-related complications. The patient’s fever and abdominal pain resolved rapidly and laboratory data showed improvement 5 days later. Although the stent was kept in place for 6 months without any additional intervention, such as removal or exchange of the stent, there were no recurrent symptoms. Fig. 1 Gallbladder punctured under endoscopic ultrasound guidance before placement of the guide wire. Fig. 2 Fluoroscopic image showing the coiled guide wire in the gallbladder. Fig. 3 Fluoroscopic image showing the placement of the stent through the gastro-gallbladder fistula. The tip of the stent was positioned in the gallbladder. Fig. 4 Endoscopic view of the stent inserted into the gallbladder from the antrum of the stomach. Endoscopy_UCTN_Code_TTT_1AS_2AD