Background: Endoscopic transpapillary gallbladder stenting (ETGBS) has been used as an alternative to percutaneous cholecystostomy in patients with acute cholecystitis who are considered unfit for surgery. However, there are few data on the efficacy and safety of ETGBS replacement of percutaneous cholecys- tostomy in high-risk surgical patients. This study aimed to evaluate the feasibility, efficacy, and safety of ETGBS to replace percutaneous cholecystostomy in high-risk surgical patients. Methods: This single center retrospective study reviewed the data of patients who attempted ETGBS to replace percutaneous cholecystostomy between January 2017 and September 2019. The technical success, clinical success, adverse events, and stent patency were evaluated. Results: ETGBS was performed in 43 patients (24 male, mean age 80.7 ± 7.4 years) to replace percu- taneous cholecystostomy due to high surgical risk. The technical success rate and clinical success rate were 97.7％ (42/43) and 90.5％ (38/42), respectively. Procedure-related adverse events and stent-related late adverse events occurred in 7.0％ (3/43) and 11.6％ (5/43), respectively. Of the patients who success- fully underwent ETGBS ( n = 42), only one had recurrent acute cholecystitis during follow-up. The median stent patency was 415 days (interquartile range 240–528 days). Conclusions: ETGBS, as a secondary intervention for the purpose of internalizing gallbladder drainage in patients following placement of a percutaneous cholecystostomy, is safe, effective, and technically feasi- ble. Thus, conversion of percutaneous cholecystostomy to ETGBS may be considered as a viable option in high-risk surgical patients.