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