Background/Objectives: Acute cholecystitis in patients with malignant biliary obstruction (MBO) is challenging to manage. Evidence for endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using double-pigtail plastic stents (DPPS) in this setting remains limited. We evaluated the efficacy and safety of EUS-GBD using DPPS for acute cholecystitis in patients with MBO. Methods: We retrospectively reviewed 41 consecutive patients who underwent EUS-GBD using DPPS at two centers. The primary endpoint was technical success; secondary endpoints included clinical success, adverse events, recurrence, and subsequent oncologic treatment. Results: Technical success was achieved in 95.1% (39/41), with clinical success in all technically successful cases. Adverse events included biliary peritonitis (14.6%) and procedure-related DPPS migration (2.4%). Recurrence occurred in 2.6% of patients. Systemic therapy was resumed in 10 of 18 patients (55.6%) at a median of 15 days after EUS-GBD. Conclusions: EUS-GBD using DPPS achieved high technical and clinical success rates with a low recurrence rate in selected patients with acute cholecystitis and MBO. Systemic therapy could be resumed in a subset of patients following successful drainage. These findings suggest that DPPS-based EUS-GBD may be a feasible internal drainage option in this setting, although prospective comparative studies are needed to further establish its safety and effectiveness.

Objectives: Endoscopic papillectomy (EP) is a minimally invasive treatment for ampullary tumors; however, its safety in elderly patients remains unclear. We aimed to evaluate the feasibility and clinical outcomes of EP in this population. Methods: This multicenter retrospective study included 255 patients with ampullary tumors who underwent EP between April 2008 and September 2025 at three collaborating institutions. Patients aged ≥ 75 years were defined as elderly; complication rates and clinical outcomes were compared with the non‐elderly group. Results: The elderly group had a significantly higher Charlson Comorbidity Index (1.0 [0–8] vs. 0 [0–7]; p = 0.028). The elderly group demonstrated significantly lower rates of overall complications (29.0% vs. 48.9%; p = 0.004), delayed bleeding (4.3% vs. 23.1%; p < 0.001), and pancreatitis (11.6% vs. 23.1%; p = 0.041) than the non‐elderly group. Serious complications rate (4.3% vs. 4.8%; p = 1.000), median hospital stay (12 [7–73] vs. 13 [4–40] days; p = 0.408) were comparable between groups. Multivariate analysis showed that age ≥ 75 years was independently associated with a reduced risk of delayed bleeding ( p = 0.002; odds ratio [OR], 0.14) and pancreatitis ( p = 0.029; OR, 0.39). Conclusions: EP in patients aged ≥ 75 years was associated with lower complication rates and may be a feasible treatment option.