Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) shows a significantly lower rate of unplanned readmissions compared to percutaneous transhepatic gallbladder drainage (PTGBD) in high-risk acute cholecystitis patients.

• Unplanned readmission rates were 7.0% for EUS-GBD versus 37.1% for PTGBD.
• Both techniques had comparable clinical success and mortality rates, but EUS-GBD consistently showed lower readmissions in all studies examined.

While EUS-GBD may be beneficial, the evidence does not universally establish it as the first-line treatment over PTGBD; further randomized trials with longer follow-up are necessary.