Endoscopic drainage of the gallbladder for acute cholecystitis can be performed with the transpapillary method or EUS-guided method. EUS-guided gallbladder drainage (EUS-GBD) is gaining popularity as the treatment of choicefor acute cholecystitis in patients that are a high-risk for cholecystectomy. It provides an alternative to percutaneous drainage and laparoscopic cholecystectomy in these patients. With the development of lumen apposing metal stents, the procedure is associated with high rates of technical and clinical success with low rates of adverse events. The aim of this lecture is to provide an overview in the current status of EUS-guided gallbladder drainage including the indications, techniques, stent systems in-use and how the procedure compares to conventional techniques are outlined. Furthermore, the feasibility of cholecystoscopy and advanced gallbladder interventions is explored. Finally, a comparison in outcomes of EUS-GBD versus laparoscopic cholecystectomy is provided giving some initial data in support of the procedure as an alternative to surgery in a selected group of patients.