LAUSR

Figure 2. EUS image showing the size of gallstone (2.6 1.9 cm). We present the case of a 65-year-old woman who had recurrent cholecystitis for gallstones. However, surgical cholecystectomy was not advisable because of her long history of heart disease. In addition, she refused surgical treatment. She had experienced another severe recurrence of acute cholecystitis after eating greasy food 2 months earlier. CT and magnetic resonance imaging suggested a giant gallstone and acute cholecystitis (Fig. 1). EUS showed that the stone size was 2.6 1.9 cm (Fig. 2). After 3 days of anti-infection therapy, no significant improvement appeared. The patient agreed to undergo EUS-guided gallbladder drainage with lumen-apposing metal stents (LAMSs), and she hoped to extract the gallstone. All procedures were performed after she signed an informed consent. The patient was placed in a horizontal position under single-lumen intubated anesthesia. A linear echoendoscope (GIF-UCT260; Olympus Medical, Tokyo, Japan) was used. EUS-guided transduodenal puncture was performed with a 19G needle (EchoTip Access Needle; Cook Medical, Bloomington, Ind) with color Doppler followed by placement of a 0.035-inch guidewire (Fig. 3). Sterile normal saline solution was used for gallbladder aspiration and