Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged as a popular alternative to percutaneous cholecystostomy and endoscopic transpapillary gallbladder drainage for patients suffering from acute calculous cholecystitis who are at high risk for surgery. Multiple cohorts, meta-analyses, and a randomized controlled trial have shown that EUS-GBD has lower rates of recurrent cholecystitis and unplanned reinterventions, while achieving similar technical and clinical success rates than transpapillary cystic duct stenting. The essential steps, precautions in performing EUS-GBD and long-term management will be discussed in this article.