Conversion endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is as effective and safe as primary EUS-GBD in acute cholecystitis, crucial for high-risk surgical patients.

• Technical success rates were similar: 98.3% for primary EUS-GBD vs. 95.8% for conversion EUS-GBD.
• Despite longer initial procedure times for conversion (adjusted later), overall safety metrics were comparable.

Consider conversion EUS-GBD in cases where primary approaches are unsuitable; it offers similar outcomes without increasing risk.

• Patient profiles differed, with conversion groups having higher malignancy rates and comorbidities.