Endoscopic management of a nasobiliary drain migrated into the gallbladder.

Background and Aims: Endoscopic gallbladder-preserving cholecystolithotomy is a potential alternative to laparoscopic cholecystectomy for patients desiring gallbladder preservation and meeting biliary lithotripsy indications. This article reports a case of initial endoscopic failure requiring multiple interventions, highlighting the importance of individualized decision-making and multitechnique integration in complex cases. Methods: A 61-year-old man with gallstones refused laparoscopic cholecystectomy and underwent ERCP-guided gallbladder-preserving cholecystolithotomy. To minimize sphincter injury, limited endoscopic papillotomy (EPT) with large-balloon dilation (EPLBD) was performed, followed by nasobiliary drain to aid residual microstone clearance and assess gallbladder function recovery. However, due to inappropriate postoperative management, the drain migrated into the gallbladder, necessitating repeated endoscopic procedures including ERCP, cholecystoscopy, and multiple device-assisted foreign body retrieval. Results: Despite initial failure, the integration of multiple endoscopic techniques enabled successful removal of gallstones and the displaced drain, with maximal preservation of gallbladder function. For patients who wish to preserve gallbladder function, gallbladder-preserving cholecystolithotomy combined with EPT and EPLBD may be a viable option. Conclusions: Successful outcomes in complex cases depend on tailored endoscopic strategies and careful preoperative planning. Clinical decision-makers should pay more attention to the strategy of applying individualized endoscopic techniques to improve the prognosis of patients.