For high-risk patients with acute cholecystitis, conversion to endoscopic ultrasound-guided gallbladder drainage after percutaneous drainage achieved outcomes comparable to primary drainage.

• Multicenter study of 141 patients: technical success was 95.8% after conversion versus 98.3% with primary drainage.
• Results remained comparable after adjustment, despite more cancer and greater comorbidity in the conversion group.
• Clinical success, adverse events, and stent patency were similar between groups.

Conversion procedures initially took longer, but procedure times became comparable after adjustment. When primary endoscopic drainage is unsuitable, surgeons and endoscopists can consider conversion using the existing percutaneous catheter to distend the gallbladder.