Surgeons can safely use endoscopic ultrasound-guided gallbladder drainage in patients with inoperable acute cholecystitis and Niemeier type II perforation.

• Technical success was 100% in 14 patients treated with electrocautery-enhanced stents.
• Clinical success reached 92.9% with only mild adverse events, and no severe complications after a median follow-up of 315 days.

Consider this approach in high-risk cases previously deemed inoperable, as it may improve patient outcomes.