EUS-guided gallbladder drainage using a bicolored double-pigtail plastic stent facilitates appropriate stent positioning

The Tokyo Guideline 18 states that drainage, including percutaneous, transpapillary, or transmural approaches, should be considered for fragile patients with moderate acute cholecystitis [1] [2]. With transmural endoscopic ultrasound-guided gallbladder drainage (EUS-GBD), cutting-edge electrocautery-enhanced lumen-apposing metal stents (LAMSs) are key devices in certain regions [3]. However, a double-pigtail plastic stent (DPPS) is still used in areas where LAMSs are inapplicable [4]. Previous unicolored DPPSs had a positioning marker; however, physicians hesitate to move the stent in either direction if this marker is not in the endoscopic view. Recently, a bicolored DPPS has emerged to facilitate appropriate stent positioning in the endoscopic view.